Development of macular hole and macular retinoschisis in eyes with myopic choroidal neovascularization

PURPOSE: To determine whether the chorioretinal atrophy (ChRA) adjacent to a choroidal neovascularization (CNV) is related to the development of a macular hole or macular retinoschisis in highly myopic eyes. DESIGN: Observational case series. METHODS: One hundred and eighty-one eyes of 125 patients with high myopia were divided into three groups: group 1 had a myopic CNV surrounded by ChRA larger than 1 disk area (43 eyes), group 2 had a myopic CNV surrounded by a ChRA smaller than 1 disk area (45 eyes), and group 3 did not have CNV (93 eyes). Optical coherence tomography (OCT) was used to evaluate the macular morphologic features, for example, macular holes and macular retinoschisis. RESULTS: A macular hole was detected by OCT in six eyes (14%) in group 1 and in none of the eyes in groups 2 and 3. The hole always existed at the border between an old CNV and the surrounding ChRA. A macular retinoschisis was detected in four eyes (9%) in group 1 and in eight eyes (9%) in group 3. The macular retinoschisis seen in group 1 appeared markedly less column-like than those in group 3. It was somewhat difficult to differentiate a retinal detachment from retinoschisis in the eyes in group 1. CONCLUSIONS: Eyes at the atrophic stage of myopic CNV have a higher risk of developing a macular hole, and we recommend periodic OCT examinations for macular holes or macular retinoschisis, even in asymptomatic, highly myopic eyes, after the CNV has progressed to the atrophic stage.