PURPOSE: To evaluate the clinical efficacy and safety of posterior scleral contraction (PSC) in the treatment of myopic traction maculopathy (MTM) by three-dimensional magnetic resonance imaging (3D MRI), swept-source optical coherence tomography (SS-OCT) and swept-source optical coherence tomography angiography (SS-OCTA). METHODS: In this prospective study, 30 eyes of 25 patients with MTM were treated with PSC. The ocular parameters of the patients were measured before surgery and at 1 month, 6 months, and 1 year after 3D MRI and SS-OCT/OCTA. RESULTS: The differences in preoperative and postoperative parameters, including axial length (AL), spherical equivalent (SE), best-corrected visual acuity (BCVA), retinoschisis area, total posterior staphyloma height (PSH), and vitreous volume were statistically significant (P <
0.001). The choroidal thickness (CT) in each sector, choroidal perfusion area (CPA) in subfoveal and temporal sectors, and choroidal vascularity index (CVI) in inferior and temporal sectors increased significantly after PSC surgery (P <
0.05). Additionally, 3D MRI showed that the surgical strips remained strong and stable during the follow-up period, without complications such as strip displacement, fracture, and loosening. CONCLUSIONS: The application of 3D MRI and SS-OCT/OCTA in assessment of the treatment of MTM with PSC was comprehensive with multiple ocular parameters and could further guide the clinical diagnosis and treatment of MTM. TRANSLATIONAL RELEVANCE: We combined SS-OCT/OCTA and 3D MRI to provide the basis of a theory for guiding the clinical diagnosis and treatment of MTM.