Abstract
Myopic traction maculopathy (MTM) is considered a preexisting lesion of macular hole retinal detachment. The diagnosis of MTM is made by the existence of one of the macular lesions; epiretinal membrane, vitreomacular traction, retinal thickening, retinoschisis, macular hole (lamellar or full thickness), and retinal detachment. Tokyo Medical and Dental University (TMDU) classification of MTM is established based on the size and the location of the retinoschisis and the presence of six foveal pathologies. Progression from retinoschisis to retinal detachment is classified into four stages starting with a development of outer lamellar hole.
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The terminology of myopic macular retinoschisis, myopic foveoschisis, or myopic retinoschisis has not been consistent. Retinoschisis is the most frequent form of tractional retinal changes before the development of a macular hole retinal detachment (MHRD) in eyes with pathologic myopia [1]. However, in some eyes, MHRD can develop without retinoschisis. Panozzo et al. [2] proposed to unify all of the pathologic features generated by traction in the myopic environment under the name of myopic traction maculopathy (MTM) in 2004. The diagnosis of MTM is made by the existence of one of the macular lesions; epiretinal membrane, vitreomacular traction, retinal thickening, retinoschisis, macular hole (lamellar or full thickness), and retinal detachment (RD). Other causes of RDs, such as those caused by intrachoroidal cavitation [3], myopic macular neovascularization, or dome-shaped macula, should be excluded.
MTM is thought to be the preexisting lesion before the development of MHRD. Tractional mechanisms causing the MTM are diverse. Therefore, OCT images of MTM are also diverse. OCT examinations must be performed over the entire area of macula, as wide as possible with a use of wide-field OCT.
Tokyo Medical and Dental University (TMDU) classification of MTM is shown in Table 18.1. Firstly, the images over the entire area of the retinoschisis need to be thoroughly examined. Retromode imaging is also useful for detecting a characteristic fingerprint pattern at the corresponding area of the retinoschisis [4] (Fig. 18.1). When the entire area of the retinoschisis is examined, the eyes are classified into five groups based on the area and the extent of the retinoschisis: no retinoschisis (S0), extra-foveal retinoschisis (S1), foveal only retinoschisis (S2), foveal but not entire macular area retinoschisis (S3), and entire macular area retinoschisis (S4) (Fig. 18.2).
Next, other foveal pathologies should be identified in OCT images; such as an epiretinal membrane (M), a vitreomacular traction (V), an inner lamellar MH (L), a full thickness macular hole (H), a retinal detachment (D) and a retinal atrophy (A). A retinal detachment is classified into four stages according to its progression from retinoschisis [5] (Fig. 18.3). Retinal atrophy is included in TMDU classification of MTM because a retinal atrophy with outer retinal damage such as myopic macular neovascularization may worsen MTM [6], and may affect surgical outcome.
Natural course of the MTM is generally stable [7]. 3.9% showed a decrease or complete resolution of the retinoschisis. However, 11.6% had a progression of the MTM. The progression rate was high (42.9%) in the more advanced MTM (S4), whereas the progression rate was as low as 7.8% in the milder MTM, such as S1 to S3.
References
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Shimada, N. (2020). TMDU Classification of Myopic Traction Maculopathy Based on OCT and Ultra Wide-Field OCT (UWF-OCT). In: Ohno-Matsui, K. (eds) Atlas of Pathologic Myopia. Springer, Singapore. https://doi.org/10.1007/978-981-15-4261-9_18
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