Differences in the Progression between Myopic Maculoschisis Eyes with and without Macular Detachment in the Natural Course of the Disease: A Retrospective Longitudinal Study based on the New Myopic Traction Maculopathy Staging System

Purpose: To investigate the pace of visual acuity (VA) loss in myopic maculoschisis eyes with or without macular detachment (MD) and identify associated risk factors. Methods: 1334 eyes of 991 patients with high myopia were reviewed. A new myopic traction maculopathy (MTM) staging system classified four retinal stages and three foveal stages. To the MTM eyes with normal fovea, maculoschisis with and without MD was defined as stage 3a and stage 1a,2a respectively. Results: 110 (8.25%) eyes with maculoschisis were included, with a follow-up of 24.00 ± 17.47 months. Of them, 84 (76.36%) were stage 1a,2a, and 26 (23.64%) were stage 3a. The VA loss per year during the follow-up period was similar between eyes with stage 1a,2a and stage 3a (3.13 ± 12.21 VS . 3.41 ± 18.42 letters, P = 0.930). Multivariate analyses revealed that vitreomacular interface factors (VIFs) were significantly associated with VA loss during the follow-up, no matter in stage 1a,2a or stage 3a ( P = 0.039 and P = 0.038, respectively). In the stage 1a,2a group, the percentage of eyes that lost at least 10 letters at the final visit compared with the baseline visual acuity was higher in eyes with VIFs than in those without VIFs (13 eyes, 50.00% VS . 14 eyes, 24.14%, P = 0.019). Conclusion: No differences were found in VA loss pace between stage 1a,2a and stage 3a. Surgical intervention or at least more intensive follow-up should be considered for stage 1a,2a eyes with VIFs, to promote a more favorable visual outcome.