Macular Detachment – Causes, Diagnosis, Management and a Long-term Follow-up Based on a Case Series

Introduction: Macular detachment (MD) is a complex retinal disorder characterized by the separation of the neurosensory retina from the retinal pigment epithelium (RPE) within the macular region. Unlike rhegmatogenous retinal detachment (RRD), MD occurs without a visible retinal break and is primarily caused by vitreomacular traction (VMT), epiretinal membrane (ERM) formation, or myopic degeneration. Myopic tractional maculopathy (MTM) is a major contributing factor in highly myopic eyes, particularly in those with a staphyloma. The interplay between axial elongation, the stiffness of the internal limiting membrane (ILM), and progressive retinal thinning in MTM contributes to structural instability and detachment. However, MD is not exclusive to myopic eyes and can also develop in non-myopic individuals due to progressive tractional forces caused by VMT and/or ERM contraction.Material and methods: We analysed a group of 15 patients who underwent pars plana vitrectomy due to macular detachment. The following examinations were conducted preoperatively and at 10 days, 1 month, 3 months, 6 months, and 3 years postoperatively: Best-corrected visual acuity (BCVA), fundoscopic examination and optical coherence tomography (OCT) imaging. Axial length was assessed in all eyes preoperatively. Additionally, staging of myopic tractional maculopathy (MTM) and posterior staphyloma classification were evaluated in highly myopic cases. All patients underwent 23-gauge (23G) pars plana vitrectomy with ILM peeling and 20% sulphur hexafluoride (SF6) endo-tamponade. Follow-up assessments included BCVA measurement and evaluation of macular anatomical status.Results: Preoperative examinations identified MD causes as follows: VMT with ERM (8 eyes, 53.3%), myopic degeneration with MTM and posterior staphyloma (5 eyes, 33.3%) and VMT with macular neovascularisation (MNV) (2 eyes, 13.3%). Axial length in myopic eyes ranged from 25.81 mm to 29.0 mm, whereas in non-myopic eyes, it ranged from 21.34 mm to 24.18 mm. MTM stage 3 with type 1 or 2 staphyloma was noted in the myopic subgroup. Surgical success was achieved in 13 eyes (86.7%). However, two highly myopic eyes required reoperation with silicone oil tamponade due to macular re-detachment three months after the initial MD surgery. The macula remained attached following reoperation, even after subsequent silicone oil removal. Overall, BCVA improved in 10 eyes (66.7%), remained stable in 3 eyes (20%), and declined in 2 eyes (13.3%) over the 3-year follow-up.Conclusion. Long-term observations suggest that pars plana vitrectomy (PPV) with ILM peeling provides effective anatomical macular reattachment in MD. However, anatomical success does not always correlate with functional improvement.Cataract surgery in eyes with VMT syndrome may increase the risk of macular detachment, even in non-myopic individuals. VMT-related traction on the macula during ERM formation may cause MD in both myopic and non-myopic eyes.A weakened RPE pump in myopic retinas is an additional factor contributing to a poor prognosis for retinal reattachment and potential complications, even after uneventful vitrectomy. While PPV with ILM peeling remains an effective treatment for MD, it requires customised surgical approaches depending on the underlying aetiology.