SUPRA CHOROIDAL BUCKLING IN MANAGING MYOPIC VITREORETINAL INTERFACE DISORDERS

Abstract

To evaluate the efficacy of supra choroidal buckling procedure using a supra choroidal catheter, as a new approach in treating myopic vitreomacular interface disorders specially in difficult cases of myopic traction maculopathy with or without macular hole retinal detachment in posterior staphyloma depending on the concept of indenting the choroid only, from a 1-year data study. A newly developed supra choroidal catheter was used to deliver stabilized, cross-linked, long-acting hyaluronic acid as a filler in the supra choroidal space in the area of the staphyloma forming a choroidal indenting effect. Before the injection, pars plana vitrectomy was performed without internal limiting membrane peeling to avoid the risk of break of the roof of foveal detachment in case of foveoschisis. This indentation was used to treat 11 patients with myopic foveoschisis and 12 patients with myopic macular hole retinal detachment, 5 of whom had failed primary repair by vitrectomy before inclusion in this trial. Clinical and optical coherence tomographic evaluations of these patients were performed over 1-year follow-up. Retinal layer restoration was achieved in all 11 eyes with myopic foveoschisis. This was gradual over a period of 2 to 6 weeks postoperatively. No recurrence over the 12-month follow-up was observed. Visual acuity improved by 1 line or more in 9 eyes (81.8%). Of the 12 eyes, 10 with macular hole detachment (83%) showed closure of the holes in association with the resolution of the detachment; 2 eyes showed resolution of the detachment and flatting of the edge of the holes but with incomplete closure on optical coherence tomography. Eight eyes (66.6%) showed improvement in visual acuity by 1 or more lines with no recurrence of retinal detachment over the 12-month follow-up period. The indentation effect was sufficient over the 12-month follow-up period. The indentation effect achieved by supra choroidal approach can be used as a method of managing myopic foveoschisis and myopic macular hole with detachment even in eyes with failed primary vitrectomy, counteracting the role of posterior staphyloma in the role of the disease. The indentation effect is sufficient for first year of follow-up.