But presentation in the 3rd or even 2nd decade of life is not unusual. Most commonly, they present in the 5th or 6th decade of their life. Patients with myopic traction maculopathy can present from early adulthood to the later years of life. Based on the OCT picture, four retinal "types" of MTM are recognized: To date, there is no single comprehensive classification available that fits all scenarios. Myopic foveoschisis is not a single entity but a broad spectrum consisting of many clinical pictures. However, reports on such management are quite limited. Based on this etiology, some people believe that a mere peel of ILM in the temporal part of the macula might resolve the foveoschisis. Myopic foveoschisis is believed to be multifactorial in origin, and other causes of anteroposterior traction on the retina include internal limiting membrane (ILM) rigidity, vitreomacular traction, and presence of epiretinal membranes. In a few cases, there may be a resolution of schisis, but this resolution is, most of the time, temporary. Advanced stages of myopic foveoschisis usually involve macular detachment. A full-thickness macular hole is also reported in several advanced cases of myopic traction maculopathy. With the progression of the disease, in many cases, there can be the development of an inner and/or outer lamellar macular hole. The disease begins with schisis in the inner retinal layers, slowly progressing over the years, to lead to schisis in the outer retinal layers as well. Myopic traction maculopathy is a dynamic disease that gradually progresses over the years. The tractional force acting along the surface of the retina because of the increase in the size of the eyeball is responsible for the formation of a macular hole.
This anteroposterior stretch causes a perpendicular tractional force on the surface of the retina and leads to layers of the retina splitting up. The elongation of the myopic eye not only occurs along the axial length but also in a plane tangential to the retina at the posterior pole. Due to different stretch responses of the retina and choroid, differential stretching causes the retina to split up into layers. This ectasia causes a stretch in the posterior scleral wall, choroid, and the retina. In the eyes, having pathologic myopia and ectasia of the posterior scleral wall leads to posterior staphyloma, which is also called scleroconus. The pathophysiology of myopic traction maculopathy is complex. Multiple consequences of high myopia such as lacquer cracks produced by breaks in the choroid due to ectasia, choroidal atrophy, and choroidal neovascularization, can also co-exist in eyes with myopic foveoschisis. Īpart from posterior staphyloma and elongation of the eyeball, other factors contributing to etiology may be traction exerted by pre-macular cortical vitreous, stiff retinal vasculature, or internal limiting membrane rigidity. This tractional force acting along the surface of the retina because of the increase in the size of the eyeball is also responsible for the formation of a macular hole. The ectasia causes tractional forces on the retina, in a plane parallel to its surface, and also perpendicular to it, which in turn causes the layers of the retina to split up. However, the ectasia in the choroid and the retina is not similar, and this differential stretching of the retina is primarily responsible for causing myopic traction maculopathy. Antonio Scarpa, a skilled anatomist, was the first to describe "posterior staphyloma" as an abnormal outward protrusion of the eyeball owing to changes in the collagen of the scleral wall. Myopic foveoschisis, as the name suggests, is almost always seen in eyes with high myopia and posterior staphyloma. With the addition of spectral-domain optical coherence tomography (OCT), the early recognition and prompt treatment of myopic foveoschisis have been made possible. In the past, the diagnosis of MTM was difficult because of high myopic eyes offering a poor contrast when being examined by an ophthalmoscope. įoveoschisis was first described by Takano and Kishi in 1999, as a split in the layers of retina at the fovea, in eyes with posterior staphyloma. Patients of myopic foveoschisis usually present with a gradual, often progressive, painless diminution of vision in either or both eyes, which may be affected simultaneously or sequentially. These eyes often have a posterior staphyloma, which has been implicated as an etiologic factor in the pathogenesis of MTM.
Myopic foveoschisis, also known as myopic traction maculopathy (MTM) or myopic macular schisis, is a relatively rare entity that affects eyes with pathological myopia (-6.00 diopters or more of myopia).
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