Parafoveal atrophy is a rare complication of conventional macular hole surgery, but if your patient is a high myope, you may want to be on alert. A recent retrospective study suggests those with high degrees of myopia may be at greater risk.

The interventional case series included 10 eyes of 10 consecutive patients, half of whom were male, with high myopia defined as having an axial length over 26.5mm. These patients received human amniotic membrane (hAM) grafts to treat persistent or chronic macular hole with or without retinal detachment. The researchers identified postoperative parafoveal atrophy on color fundus photographs and structural OCT.

Collectively, the 10 patients had a preoperative mean axial length and macular hole diameter of 29.9mm and 881.8μm, respectively. After the hAM transplant, seven eyes had complete macular hole closure. Mean best-corrected visual acuity improved from 1.26logMAR (Snellen equivalent: 20/363) to 1.11logMAR (20/257) on follow-up.

In four of the patients, the researchers described a patchy atrophy-like depigmentation developing around the macular hole lesion as early as the first month after surgery, though none had visual worsening. No significant differences were found between those with and without parafoveal atrophy in terms of demographics, axial length, macular hole size, ocular history, preoperative and postoperative best-corrected visual acuity.

The researchers concluded that 40% of highly myopic eyes developed parafoveal atrophy after hAM graft transplantation. “The pathogenesis and long-term consequence need further investigations,” they added.

Tsai D, Huang Y, Chen S. Parafoveal atrophy after human amniotic membrane graft for macular hole in patients with high myopia. Br J Ophthalmology. July 31, 2020. [Epub ahead of print].