30.1 Features
Pathologic myopia is usually associated with chorioretinal abnormalities such as lacquer cracks, myopic choroidal neovascularization (CNV; ▶ Fig. 30.1), chorioretinal atrophy, and pigmentary degeneration. These abnormalities are the causes of the visual impairments in eyes with pathologic myopia. As the axial length is elongated and the posterior curvature of the eye is extruded posteriorly in highly myopic eyes, the retina and choroid are abnormally stretched and thin. This leads to the development of the myopic degenerative changes. Myopic traction maculopathy develops in three stages—beginning with a macular retinoschisis and foveoschisis followed by the development of a foveal detachment which subsequently progresses to a macular hole retinal detachment (MHRD) or a macular hole (MH; ▶ Fig. 30.2, ▶ Fig. 30.3, ▶ Fig. 30.4). Vitreous pockets can also be present due to tangential traction by the posterior vitreous cortex, contributing to the development of myopic tractional maculopathy.
Fig. 30.1 Fundus photograph, fluorescein angiography (FA), and optical coherence tomographic (OCT) images of myopic (−14.0 D) choroidal neovascularization (CNV). (a) Fundus photograph showing peripapillary atrophy and myopic CNV (arrow) at the fovea. (b) FA shows hyperfluorescence at the myopic CNV (arrow) with leakage at the late stage. (c) Horizontal OCT image showing a subfoveal CNV (arrow) above the retinal pigment epithelium layer with subretinal fluid and hyperreflective material above the CNV.
Fig. 30.2 (a,b) Fundus photograph and (c,d) optical coherence tomographic (OCT) images of the eye with macular myopic retinoschisis. Preoperative photograph and OCT image showing macular retinoschisis. (c) Intraoperative photograph of fovea-sparing internal limiting membrane (ILM) peeling showing trimming by a vitreous cutter of an inverted ILM (arrowheads) made visible by brilliant blue G staining. (d) Postoperative OCT image showing a reduction of retinoschisis, although the arteriolar traction (arrowheads) remains.
Fig. 30.3 (a) Fundus photograph and (b) optical coherence tomographic (OCT) image demonstrating myopic macular schisis and foveal detachment. OCT image of a vertical scan showing retinoschisis and foveal detachment. The posterior hyaloid is attached to the fovea. Outer retinal holes (arrows) can be seen at the edge of the foveal detachment.
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