Hi, my name is Taku Wakabayashi, a retina specialist at Wakabayashi Eye Center in Japan. Here at ASRS 2026 in Montreal, I gave a presentation on progression of macular atrophy after vitrectomy for myopic traction maculopathy. Vitrectomy is effective for resolving schicis and maintaining vision in patients with myopic traction maculopathy. However, even after successful surgery, some highly myopic eyes may still get worse due to progression of macular atrophy. To evaluate how often this happens and why, we conducted an international multicenter study, including 10 institutions from Japan, the United States, and India. We included patients with advanced myopic traction maculopathy that underwent vitrectomy and were followed for at least three years, excluding patients with preexisting macular holes. Main outcome measures included the incidents and risk factors for the progression of myopic maculopathy graded on fundus photographs. 131 eyes were included. 66.4% of the eyes had no progression of myopic maculopathy over three years.

However, 12.2% newly developed macular atrophy after vitrectomy, the most severe form of myopic maculopathy. Despite successful schisis resolution, the macular atrophy was significantly associated with worse visual outcomes. Risk factors for new macular atrophy included longer axial length, preoperative thinner choroidal thickness, concurrent choroidal neovascularization, and postoperative macular hole and macular hole retinal detachment. Although the pathogenesis of the new macular atrophy remains unclear, preventing postoperative macular hole and macular hole retinal detachment may be key to reducing the risk of subsequent macular atrophy because complete ILM peeling over the entire macula may result in around 10% rate of postoperative macular hole and macular hole retinal detachment. Fovea-sparing ILM peeling may provide additional benefit of reducing not only postoperative macular hole, but also subsequent macular atrophy. Finally, I'd like to thank all of my collaborators. Thank you very much.