Predicting visual outcomes after vitrectomy based on baseline visual acuity and timing of surgery for myopic traction maculopathy (SCHISIS report No.3).

Purpose: To evaluate visual outcomes after vitrectomy based on preoperative visual acuity (VA) in eyes with myopic traction maculopathy (MTM) and explore the optimal timing for surgery.

Method: Patients who underwent vitrectomy for MTM were categorized into four groups: preoperative vision of 20/25 or better (V1), worse than 20/25 to 20/50 (V2), 20/60 to 20/200 (V3), and worse than 20/200 (V4). The primary outcome was the postoperative VA at 12 months.

Results: We included 193 eyes: V1 (12 eyes), V2 (77 eyes), V3 (83 eyes), and V4 (21 eyes). Postoperative VA significantly correlated with preoperative VA (R² = 0.400, P < 0.001). Postoperative logarithm of the minimum angle of resolution VA was the best in V1 and worst in V4 (V1, 0.10 ± 0.26; V2, 0.19 ± 0.26; V3, 0.54 ± 0.44; and V4, 0.92 ± 0.54; P < 0.001). Visual improvement was highest in V4 and lowest in V1 (V1, 0.04 ± 0.26; V2, -0.12 ± 0.25; V3, -0.18 ± 0.41; and V4, -0.36 ± 0.44; P = 0.001). At 12 months, 83.3% of eyes in V1 achieved a postoperative VA of 20/25 or better, 90.9% of eyes in V2 achieved 20/50 or better, and 88.0% of eyes in V3 achieved 20/200 or better. Overall, 11.4% of eyes experienced a visual deterioration of three lines or more.

Conclusion: Vitrectomy generally maintains or improves vision in any group. Early surgery may help preserve good vision in eyes with good baseline vision and worsening symptoms; however, the risk of deterioration suggests it may not always be beneficial. Surgery at moderate visual impairment may offer a balanced benefit-risk ratio, avoiding surgery too early or too late.