Combined fovea-sparing internal limiting membrane peeling with internal limiting membrane flap technique for progressive myopic traction maculopathy

To present the anatomical and functional outcomes of combined fovea-sparing internal limiting membrane peeling (FSIP) with internal limiting membrane flap (ILMF) for myopic traction maculopathy (MTM). This is a retrospective, observational study. Included were 66 eyes of 62 patients who underwent vitrectomy with combined FSIP and ILMF (or modified ILMF) for MTM with a minimal follow-up of 6 months. Thirty-one eyes were treated with FSIP, and 35 with modified ILMF. The post-operative best-corrected visual acuity (BCVA) improved from 20/148 to 20/87 in the FSIP group (p < 0.001), and from 20/121 to 20/66 in the modified ILMF group (p < 0.001). The post-operative macular thickness (MT) reduced after FSIP (from 739.58 to 223.81 μm, p < 0.001) and modified ILMF (from 706.43 to 236.59 μm, p < .001). The degree of the improvement of BCVA and MT in both groups was insignificant. The incidence of a post-operative macular hole (MH) was 9.7% (3/31 eyes) with FSIP and 0% (0/35 eyes) with modified ILMF. All patients with a MH had foveoschisis in association with a lamellar hole (LMH) pre-operatively. After controlling the surgical technique, pre- and post-operative MT, follow-up duration, myopic atrophy maculopathy, and FD, the surgical technique showed significant effects on post-operative MH in all cases (p = 0.022) and in those with pre-operative LMH (p = 0.029). Our pilot study showed both methods result in significant anatomical and functional improvement. The combined FSIP with ILMF method may prevent post-operative macular hole development in cases with MTM and LMH.