Customized treatment for myopic traction maculopathy based on the MTM staging system: Long-term results in naïve eyes

Purpose To explore the long-term anatomical and functional outcomes in naïve patients with Myopic Traction Maculopathy (MTM) treated with either macular buckle (MB) plus pars plana vitrectomy (PPV) or primary MB as unique treatment according to MTM Staging System (MSS). Methods Retrospective study involving 206 consecutive naïve patients with MTM who underwent either MB plus PPV or primary MB. Postoperative anatomical and functional outcomes, including the MTM stage and its progression, axial length (AL), and best-corrected visual acuity (BCVA) changes, were evaluated at one month (i.e., “early follow-up”), six months (i.e., intermediate follow-up”), 12 months postoperatively (i.e., “late follow-up”) and at last follow-up ranging between 12 and 156 months postoperatively (i.e., “final follow-up”). Results Retinal and foveal anatomical results significantly improved in patients who underwent either primary MB plus PPV or MB ( p < 0.001), with 100% and 92.1% of patients who underwent complete resolution, respectively. For every MTM stage, the BCVA significantly improved over the follow-up visits. ( p < 0.001). At the last visit, 84 (41%) eyes improved to 0.5 decimal or more. In patients treated before 2020, when applying more combined PPV treatments, there was a high rate of early iatrogenic full-thickness macular holes ( p = 0.005). The results obtained since 2020, when the customized treatment was employed, led to better results without sight-threatening complications. Conclusions The MTM Staging System should be the foundation for treating MTM. It should precisely assess the optimal surgical technique and the ideal time to perform it concerning the various stages to maximize anatomical and functional success.