Myopic Foveoschisis and Macular Hole Retinal Detachment
As optical coherence tomography (OCT) became widespread, retinoschisis-like lesion is frequently recognized in highly myopic eyes with posterior staphyloma. This lesion is called myopic foveoschisis (MF) or myopic tractional maculopathy (MTM) caused by abnormal shape of the eyewall with preretinal tractional components, e.g. posterior hyaloid memberane and epiretinal mebrane. Its morphologic features include retinoschisis alone, retinoschisis with a foveal detachment, retinoschisis with a lamellar or full-thickness macular hole. These findings are considered as a precursor of macular hole retinal detachment (MHRD) and releasing traction with vitrectomy may reduce the prevalence of progression. However, as some MTM cases, especially with a lamellar macular hole or a foveal detachment, may develop full-thickness macular hole postoperatively, the indication of vitrectomy for MTMs has not been established yet. Surgical procedure to avoid postoperative complication represented by development of full-thickness macular hole is now under consideration. As to removal of the internal limiting membrane (ILM), it is considered to be beneficial in reducing epiretinal traction. However, its long term side effect on the retina is still unclear.