The Role of the Outer Lamellar Macular Hole in the Surgical Management of Myopic Traction Maculopathy

Purpose: To evaluate the anatomical and functional surgical outcomes of eyes affected by myopic traction maculopathy (MTM) with and without an outer lamellar macular hole (O-LMH). Methods: Forty-eight eyes affected by MTM were included: a study group of 24 eyes with an O-LMH and a control group of 24 eyes without an O-LMH. All patients underwent spectral-domain optical coherence tomography (SD-OCT) and were staged according to the MTM staging system. The surgical techniques applied were pars plana vitrectomy (PPV), macular buckle (MB), or combined surgery. The follow-up visit was 12 months after the latest intervention. Results: Best-corrected visual acuity (BCVA) improved significantly in both groups after surgery (p < 0.05). A successful surgical result was obtained in both groups at the final follow-up. In the study group, 3 eyes underwent PPV, 14 eyes underwent MB, and 7 underwent a combined surgery. Six patients developed an iatrogenic full-thickness macular hole (FTMH). In the control group, 5 eyes underwent PPV, 16 underwent MB, and 3 had combined surgery. Four patients developed a FTMH. In both groups, all the eyes with an iatrogenic FTMH received PPV as first surgery (alone or combined). A topographical correspondence between the interruption of the ellipsoid zone (EZ) and the backscattering phenomenon was found on OCT. Conclusion: The O-LMH is an OCT sign that may occur in eyes affected by MTM. Its presence is correlated with a higher risk of developing an iatrogenic FTMH after PPV (alone or combined) probably due to the thinner residual retinal tissue. Postoperative BCVA is not limited in eyes with an O-LMH and this may be explained by the restoration of the EZ after surgery.