Myopic Traction Maculopathy: A Clinicopathological Classification

Abstract

Purpose: To describe the pathogenesis and common features of myopic traction maculopathy (MTM) and propose a new clinical classification. Methods: A review of existing findings regarding MTM was performed, outlining features of the myopic environment that contribute to its development and diverse clinical manifestations. The findings are incorporated in a new clinically oriented classification scheme for MTM, designed to differentiate between stable and progressive variants of the disease. Results: MTM is a macular disease unique to eyes with degenerative myopia, in which the presence of a small radius and deep staphyloma play a major role. Traction may arise from taut, less elastic retinal components such as arterioles and internal limiting membrane (type 1 MTM: intraretinal traction) or by anomalous vitreoretinal adhesion (type 2 MTM: vitreoretinal traction), generating a wide spectrum of anomalies linked by retinal stretching, with a mixed form of traction present in some eyes (type 3 MTM). The most common type of intraretinal MTM is the schisis-like form, where the retina stretches at the level of the outer plexiform layer. When confined to the most concave areas of the staphyloma, MTM is usually a stable disease; however, when the fovea is involved, MTM is a slowly progressive condition that can lead to macular hole formation and posterior retinal detachment. Conclusions: MTM is uniquely characterized by differing anatomy, structural differences, and various forces on the field, distinguishable by striking optical coherence tomography images. This new classification scheme for MTM, derived from decades of observation and surgical experience, may help the clinician decide the best approach for disease management.