J Korean Ophthalmol Soc.  2012 Jul;53(7):969-976. 10.3341/jkos.2012.53.7.969.

The Macular Buckling Procedure for Retinal Detachment Associated with a Macular Hole in High Myopia

• Park DY
• Kim JH
• Ha HS
• Kang SW

• KMID: 2215855
• DOI: http://doi.org/10.3341/jkos.2012.53.7.969

Abstract

PURPOSE
To evaluate the long-term anatomical and functional results of macular buckling for retinal detachment associated with a macular hole in high myopia.
METHODS
Eleven consecutive highly myopic eyes with retinal detachment and macular holes were retrospectively studied between January 2002 and September 2010. All cases developed after pars plana vitrectomy for internal limiting membrane removal, for the treatment of retinal detachment associated with a macular hole, or vitreomacular traction with a macular hole. Macular buckling with an episcleral sponge was performed for all cases. The mean follow-up period after macular buckling was 45.1 months (range from 12 to 102 months). Retinal reattachment and macular hole closure after the surgery and best-corrected visual acuity before and after the surgery were evaluated.
RESULTS
Nine out of 11 eyes were successfully treated with the macular buckling procedure. In the remaining 2 eyes, retinal re-detachment occurred with anterior proliferative vitreoretinopathy. In these eyes, successful retinal attachment occurred after reoperation with silicone oil tamponade. Optical coherence tomography (OCT) was performed after the surgery in 10 out of 11 eyes and the macular hole closure rate was 30%. The mean best corrected visual acuity went from counting fingers preoperatively to 0.06 postoperatively.
CONCLUSIONS
The macular buckling procedure is effective for retinal detachment associated with a macular hole in high myopia, especially following an unsuccessful pars plana vitrectomy with removal of inner retinal traction.

Keyword

Macular buckle; Macular hole; Retinal detachment

MeSH Terms

Eye
Fingers
Follow-Up Studies
Membranes
Myopia
Porifera
Reoperation
Retinal Detachment
Retinal Perforations
Retinaldehyde
Retrospective Studies
Silicone Oils
Tomography, Optical Coherence
Traction
Visual Acuity
Vitrectomy
Vitreoretinopathy, Proliferative
Retinaldehyde
Silicone Oils

Figure

• 

  Figure 1 Schematic drawing of macular buckling procedure (Surgeon's view, Right eye). The globe is rotated nasally with traction sutures to expose the posterior scleral surface*. Horizontal mattress suture is placed at the posterior part of the globe before the placement of sponge (arrow). Temporarily resected lateral rectus (LR) muscle and inferior oblique (IO) muscle and their original insertions are also showed. X = The location of the macular hole marked on the posterior scleral surface where the sponge will be placed.

• 

  Figure 2 Pre and postoperative fundus photographs (left) and vertical optical coherence tomography (OCT) images through the macula (right) of patients with myopic macular hole and retinal detachment after (A) 4 years, (B) 7 years, (C) 10 months, and (D) 2 months of episcleral macular buckling, respectively. (A) Case 1, (B) Case 3 = OCT images show indentation of the retina-choroid-sclera complex in the macular area with closed macular hole. (C) Case 7, (D) Case 8 = OCT images reveal macular indentation without subretinal fluid despite the persistent macular hole.

• 

  Figure 3 Serial optical coherence tomography (OCT) images taken after episcleral macular buckling (EMB) for Case 7. OCT images taken (A) 1 month after EMB, (B) 2 months after EMB, (C) 3 months after EMB, (D) 5 months after EMB, and (E) 10 months after EMB show gradual decrease of the height of the macular buckle.

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