Parolini Barbara, Palmieri Michele, Finzi Alessandro, Besozzi Gianluca, Frisina Rino
Eyecare Clinic, Brescia, Italy.
Policlinico St. Orsola-Malpighi, University of Bologna Hospital of Bologna Sant'Orsola-Malpighi Polyclinic, Bologna, Italy.
Asia Pac J Ophthalmol (Phila). 2021 Jan 20;10(1):49-59. doi: 10.1097/APO.0000000000000347.
Myopic traction maculopathy (MTM) is a complex disease affecting approximately 30% of eyes with pathologic myopia. A review of the history of treatment of MTM with success rates and limitations of different surgical techniques are reported.The pathogenesis, the definition and the management were clarified in a recent study(cit). The MTM Staging System (MSS) table summarizes all the stages of MTM offering insights on the pathogenesis and natural evolution of the disease.Guidelines of management of MTM were therefore proposed, but customized for each stage.Initial stages 1a and 2a, which define maculoschisis in the inner or inner-outer or only outer layers of the retina, should be observed. Stages 3a and 4a, defining macular detachment with and without associated schisis, should be treated with a macular buckle (MB).Stage 1b, which is a lamellar macular hole in a myopic eye, should be treated with pars plana vitrectomy (PPV) only in symptomatic cases. Stages 2b, 3b, and 4b should be treated with a MB and PPV should be added in a second step only if the presence of a lamellar macular hole requires intervention to improve visual function.Stage 1c, which is a full thickness macular hole in a myopic eye, should be treated with PPV. Stages 2c, 3c and 4c should be treated with a combination of simultaneous MB + PPV to treat both the retinal pattern of schisis or detachment and the full thickness macular hole.
近视性牵引性黄斑病变（MTM）是一种复杂的疾病，约30%的病理性近视患者会受其影响。本文报道了MTM治疗史，以及不同手术技术的成功率和局限性。近期一项研究（引用文献）对其发病机制、定义及治疗方法进行了阐明。MTM分期系统（MSS）表总结了MTM的所有阶段，为该疾病的发病机制和自然演变提供了见解。因此，提出了MTM的治疗指南，但针对每个阶段进行了定制。定义为视网膜内层或内-外层或仅外层出现黄斑劈裂的初始1a期和2a期，应进行观察。定义为伴有或不伴有相关劈裂的黄斑脱离的3a期和4a期，应采用黄斑扣带术（MB）治疗。1b期为近视眼的板层黄斑裂孔，仅在有症状的情况下采用玻璃体切割术（PPV）治疗。2b期、3b期和4b期应采用MB治疗，仅在存在板层黄斑裂孔需要干预以改善视功能时，第二步才添加PPV。1c期为近视眼的全层黄斑裂孔，应采用PPV治疗。2c期、3c期和4c期应采用MB联合PPV同时治疗，以处理视网膜劈裂或脱离的形态以及全层黄斑裂孔。
