Myopic maculoschisis (macular schisis) is fairly uncommon and wasn’t recognised until advances in optical coherence tomography (OCT) imaging. This is because it is not usually visible on examination.
The basic problem is the same as epiretinal membrane, where a thin sheet of scar tissue forms on the surface of the macula. In patients with epiretinal membrane, the macula becomes wrinkled first and then thickens because of the contraction of the membrane and some resulting leakiness of the retinal blood vessels. In myopic maculoschisis, the macula seems to split because an area of the back of the eye develops an extra bulge backwards. This ‘outpouching’ is called a posterior staphyloma and can be progressive.
How Does Myopic Maculoschisis Affect the Eye?
It is thought that, rather than the whole macula stretching out backwards with the back of the eye and following its shape, the epiretinal membrane stays where it is as the back of the macula moves with the wall of the eye. The outcome of this is that the macula is stretched out from the back to the front and the macula splits.
Patients may develop blurred central vision and rarely notice distortion, but the condition may progress fairly quickly in some people – some key findings on OCT scans can predict whether this is likely to occur.
Treatment for Myopic Maculoschisis
If treatment is chosen, this consists of a vitrectomy that is the same as that for epiretinal membrane. The surgery involves the removal of vitreous gel and the peeling of the epiretinal membrane and inner limiting membrane. The duration of the surgery is usually 20 to 30 minutes, with the recovery time varying from between three to six months. Potential risks of the operation include a less than 1 in 1000 chance of blindness, a less than 1 in 200 lifetime risk of retinal detachment, and a 1 in 50 chance of experiencing reduced vision.
After the surgery, it’s normal to experience some surface irritation initially, but the operated eye should not be painful. To avoid post-op complications, air travel must be avoided in the week following the operation and a shield must be worn while sleeping to protect the eye.
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