To the Editor:
We read with interest the article “Myopic Traction Maculopathy in Fovea-Involved Myopic Chorioretinal Atrophy” by Lee et al. [1]. The authors present important findings suggesting that MTM may exacerbate atrophy progression and that early surgical intervention could help mitigate this. These conclusions need careful consideration in light of the significant variability in anatomy and pathology seen in these patients.
The inverted ILM flap technique offers structural stabilization in many cases, but its application in advanced atrophy is fraught with challenges. Staining and identifying the ILM are particularly difficult due to poor dye uptake and the indistinct foveal anatomy. Peeling the ILM in these cases risks creating iatrogenic macular holes, which, in the absence of retinal pigment epithelium (RPE), can lead to severe visual loss. These technical hurdles highlight the critical need for surgical precision and the potential dangers of intervention in advanced stages.
The anatomical variability also complicates decision-making. Different staphyloma types, as previously described [2–4], can influence the disease course and outcomes. Type 2 staphyloma, emphasized in Lee et al. [1], is one factor, but the degree of traction, extent of atrophy, and epiretinal membrane involvement all demand individualized strategies. Universal guidelines are difficult to establish in such a diverse patient population.
We agree that early intervention may help slow atrophy progression, but careful patient selection is essential. Enhanced imaging techniques could aid in identifying those most likely to benefit from surgery, avoiding unnecessary risks in patients unlikely to gain significant visual improvement.
In conclusion, while the study supports early surgical intervention in MTM, the technical challenges and patient variability underline the need for a tailored approach. Further research should focus on refining surgical methods and developing stratified guidelines to improve outcomes for these complex cases.
Author contributions
MM wrote the letter; AM and LF provided feedback on the letter.
Competing interests
The authors declare no competing interests.
Footnotes
Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
References
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