Staging myopic traction maculopathy

Classification system proposed for better management of traction maculopathy

Dermot McGrath

Posted: Tuesday, September 1, 2020

Barbara Parolini MD

A proposed new classification system for myopic traction maculopathy (MTM) may help clinicians to more accurately predict the course of the disease and orient management strategies for better outcomes, according to Barbara Parolini MD.

“MTM is not one disease but a spectrum of clinical pictures. There is no comprehensive classification, and there is no consensus on management. We have tried to remedy this with a classification system that offers not just an easier means to remember all the distinct types of MTM, but more importantly to correlate them to prognosis and treatment,” she told delegates attending the 19th EURETINA Congress in Paris.

Dr Parolini, Director of the Vitreoretinal Service at EYECARE CLINIC in Brescia, Italy, carried out a series of studies in recent years to study the natural history and pathogenesis of MTM and tried to propose the best management for each type of MTM encountered.

The first phase of the study included 281 eyes with MTM that had been operated by Dr Parolini between 2006 and 2018. All of the MTM subtypes were classified based on preoperative OCT analysis. The distinct MTM types identified in the series included four retinal patterns (1. inner-schisis or innerouter schisis, 2. outer schisis, 3. schisis detachment and 4. detachment) and three foveal patterns (a. intact fovea, b. inner lamellar macular hole, c. full thickness macular hole).

The study established a statistically significant correlation between types of MTM and the age of the patients, with the lower type 1 MTM typically found in younger patients. Following on from this, a phase II longitudinal study was carried out to study the natural evolution of MTM in 126 unoperated eyes with at least three OCTs taken at different time points with at least a one-year interval among them and with up to 11 years’ follow-up.

“Considering the correlation between type of MTM and age and the evolution of MTM types in the same eye, we concluded that MTM should not be divided into types but into stages,” said Dr Parolini. The proposed MISS classification (MTM Italian Staging System) details the patterns of evolution from type 1, 2, 3 and 4 in the retina as well as types a, b, and c in the fovea.

“For each type we show the mean best-corrected visual acuity (BCVA) and also the mean time taken to evolve between one stage and the next,” said Dr Parolini.

To find a good correlation with treatment, Dr Parolini conducted a review of 157 eyes with MTM operated with macular buckle (MB), pars plana vitrectomy (PPV) and combined PPV and MB, with analysis of anatomical and functional response to each treatment per each stage.

“The conclusions were that retinal patterns from schisis to detachment could be better solved with a macular buckle while the foveal pattern with splitting into the fovea should be treated with PPV and manoeuvre with the internal limiting membrane. When schisis and/or detachment are combined with a macular hole, macular buckle can be combined with PPV and ILM management”, she said.

Barbara Parolini: