Current concepts of macular buckle in myopic traction maculopathy

Abstract

Since its introduction by Charles L. Schepens, macular buckle (MB) surgery has evolved over the past 60 years. Optical coherence tomography (OCT) has given a paradigm shift to the understanding of myopic macula, thereby helping in objective evaluation of the various manifestation of traction maculopathy. Staphyloma evaluation by ultrasound, wide-field fundus photography, and MRI scans along with OCT has led to the resurgence of MB surgery in the treatment of myopic traction maculopathy (MTM). Various surgical techniques with different buckle materials are being performed with encouraging anatomical and functional success rates. This article reviews the literature to explain the current concept of MB surgery based on its evolution, different kinds of buckle materials, rationale for planning MB surgery, and different surgical techniques for the management of MTM.

Posterior pole retinotomy for treatment of recurrent macular hole retinal detachment in highly myopic eyes: a pilot study

“…The principle of these surgeries is to reinforce the weak area of the sclera at the posterior pole with special supporting materials in order to reduce the distance between the retina and the sclera [ 25 ]. Although this type of surgery has been shown to increase the success of retinal reattachment, it is complex and carries risks of multiple complications, including ischemic injury from the ocular tissue compression (especially the optic nerve or the choroid in the macular area), rejection of the supporting materials, astigmatism, submacular hemorrhage, malposition of buckle, and prolapse of orbital fat [ 26 ]. In addition, the exoplant materials used in macular buckle surgery are not commercially available in China, which limits the application of this surgery.…”

Correlation of morphological characteristics of staphyloma with the structural and functional outcomes of myopic traction maculopathy after macular buckle surgery

“…In cases of MTM with macular hole retinal detachment and staphyloma, macular buckle had better surgical outcome, better gain in visual acuity, and lesser need for re-surgery. [ 23 ]…”

OCT Findings in Myopic Traction Maculopathy

“…In eyes with MTM secondary to epiretinal membrane formation, additional removal of epiretinal membrane is required. MTM caused by intrinsic stiffening of the ILM requires peeling of ILM with or without the placement of macular buckle [20,21]. Few studies have shown that sparing a small island of ILM over the fovea in eyes with MTM can prevent the development of post-operative MHs which are usually difficult to fix [22,23] (Table 2).…”