Long-Term Postoperative Structural and Functional Evaluation in Myopic Foveoretinal Detachment

Abstract

Purpose: Avoidable severe visual sequelae are prevalent among highly myopic eyes. We analyzed the postoperative incidence of myopic traction maculopathy (MTM) progression and long-term postoperative structural and functional findings after macular surgery for myopic foveoretinal detachment (FRD). Methods: A retrospective, consecutive, comparative, interventional, one-surgeon, multicenter control case series was conducted on 35 highly myopic eyes of 31 patients who underwent fovea sparing internal limiting membrane removal technique for myopic FRD between October 2016 and April 2020. Long-term postoperative SD-OCT and functional follow-up evaluations with microperimetry, chromatic campimetry and multifocal electroretinography were performed. The main outcome was the incidence of surgical success and progression of myopic FRD. Results: The mean evolution time of myopic FRD was 6.2 ± 3.5 months. The mean follow up time was 23.9 ± 12.1 months. The mean time for the myopic FRD resolution was 5 ± 2.1 weeks. Using a paired-samples permutation test, we found that surgery was associated with a significant improvement in visual acuity: BCVA (in logMAR) decreased from 0.87 ± 0.15 pre-surgery to 0.48 ± 0.52 logMAR, with P = 0.00075. Thirty-two eyes (91.4%) showed resolved myopic FRD. Three eyes (8.5%) showed progression: Two (5.7%) developed a full-thickness macular hole, and one (2.8%) developed a macular hole retinal detachment. Postoperative test results revealed retinal sensitivity abnormalities in 10-2 and 30-2 visual-field examinations in 18 of 19 eyes (94.7%) examined; 16 of 17 eyes (94.1%) tested showed an abnormal response on microperimetry with a stable foveocentral fixation pattern, and 20 of 21 eyes (95.2%) tested showed a profound reduction in N1and P1wave amplitudes. Conclusions: Results showed a high incidence of microstructural regression (91.4%) with low incidence of MTM structural progression after surgery (8.5%). Long-term structural and functional evaluations revealed an abnormal macula.