Retina Rocks, the image bank of the Retina World Congress, is a free, open-source online image library whose mission is to help educate the world’s eye care providers about why the retina rocks!
| Image Gallery | Over 51,000 multimodal images |
| Reference Library | Over 14,000 annotated citations from the major eye journals |
| Cases Atlas | Over 1,550 case studies organized by disease entity |
| Access our Instagram feed @retina.rocks | |
| Wall of Fame | Look here for the best submitted cases and images |
Have a comment or question about today's case? Go to your favorite social media platform to join the conversation!
Barbara Parolini and Tommaso Pellegrino
This 64YO female has a history of high myopia with posterior staphyloma. The axial length is 24.8 mm. Vision in the right eye has been deteriorating to 20/40.
Optos color RG imaging shows a posterior staphyloma, Type I (wide macula), in the right eye, which encircles the macula and disc. Ultra-widefield OCT (DreamOCT Intalight, 26 mm scan) shows a partial posterior vitreous detachment over the macula into the staphyloma with inner and outer retinal schisis within the staphyloma. There is no retinal detachment.
Learning Points:
Pathologic or high myopia is usually defined as a refractive error of at least -6 diopters with an axial length of at least 26.5 mm, so our patient technically is not a ‘high’ myope. 3D MRI imaging allows for a more nuanced definition and has shown that the ocular deformations can affect the entire eye, the equatorial, or just the posterior globe (Luo et al, JAMA Ophthalmology 2023;141:768-774). As defined by Luo et al, our patient has a posterior bulb-shaped globe. The ultra-widefield OCT is designed to image the entire posterior profile of the eye, which shows the geometry of our patient’s staphyloma.
The image also shows that myopic traction maculopathy (MTM) underlies a partial vitreous detachment. This confirms that the main cause of MTM is not the vitreous but the posterior staphyloma. Furthermore, when looking at the horizontal scan, the thickness of the retina (or, in other words, the severity of the schisis) is not evenly distributed into the staphyloma. It is more pronounced in the temporal side of the macula. The optic nerve pushes the sclera anteriorly, buckling the retina in that area and releasing the traction.
In the vertical scan, the schisis is uniformly distributed in the whole staphyloma. According to the ATN (atrophic, tractional, and neovascular) classification system for myopic maculopathy (Ruiz-Medrano et al, Progress Retinal Eye Research 2019;69:80-115), our patient has A1 (tessellated fundus only), T2 (inner + outer foveoschisis), and N0 (no myopic CNV). According to the myopic traction maculopathy staging system (MSS, Parolini et al, Ophthalmic Surg Lasers Imaging Retina 2023;54:153-157), our patient is affected by MTM in Stage 2a (predominantly outer macular schisis with no macular hole).
Retina. 2026 Aug 1;46(8):1345-1362. doi: 10.1097/IAE.0000000000004871.
PPV for large high myopic macular holes: Closure rates lower than non-high myopic eyes but get closure with meaningful VA gains — Retrospective, global, 499 eyes.
Purpose: To characterize the surgical management and outcomes of large high myopic macular holes (HMMHs).
Methods: Global multicenter retrospective case series of HMMHs with minimum linear diameter ≥ 400 µ m undergoing surgery between 2013 and 2023 with follow-up ≥ 3 months. The main outcome measure was the HMMH closure rate at postoperative Month 3.
Results: Four hundred and ninety-nine cases of 463 patients from 37 surgeons were included, with mean ± SD age 58.3 ± 12.2 years, 77.0% female, 77.4% primary, 22.6% refractory, and mean ± SD follow-up 18.8 ± 20.2 months. The mean ± SD (range) minimum linear diameter was 649 ± 280 (400, 2,759) µ m. Surgery techniques included 127 internal limiting membrane peels, 285 internal limiting membrane flaps, 19 amniotic membrane transplantations, 36 autologous retinal transplantations, and 32 others. The postoperative Month 3 closure rate for all cases was 72.4%. Closure rates significantly decreased with greater CLOSE Study Group size classification for HMMHs treated with internal limiting membrane peeling or internal limiting membrane flap ( P = 0.006) but not for HMMHs treated with amniotic membrane transplantations or autologous retinal transplantations ( P > 0.05). Visual acuity significantly increased from baseline to each follow-up time point among all eyes, with a final mean ± SD change in visual acuity of -0.29 (0.55) logMAR (+14.5 early treatment diabetic retinopathy study letters), which did not significantly differ by surgery type.
Conclusion: High myopic macular hole closure rates are lower than those reported for macular holes in nonhighly myopic eyes, but most eyes can still achieve anatomical closure and meaningful visual acuity gains when treated with the appropriate technique.
Receive Retina Rocks content in the RWC monthly newsletter!
Retina Rocks is the image bank of the Retina World Congress.
