Macular Buckling Research Articles

Outcomes of macular buckling with a T-shaped buckle for myopic tractional maculopathies associated with posterior staphyloma: An Indian experience.

Purpose:To report the anatomic and visual outcomes following macular buckling in patients affected by pathological myopia-associated foveoschisis (FS) and macular detachment with or without macular hole (MH).Methods:A retrospective interventional consecutive case series wherein 25 highly myopic eyes (mean axial length 28.46 mm; range, 25–33.8 mm) of 24 patients (16 females and 8 males; mean age 54.1 years; range, 35–74 years) presenting with macular detachment associated with a posterior staphyloma (PS), who underwent macular buckling, were evaluated. Patients with absence or reduction in subretinal fluid by more than 90% during the final follow-up along with inversion of contour of staphyloma were considered to have a successful anatomical outcome and those with improvement or maintenance in visual acuity were considered to have a successful functional outcome. The mean duration of follow-up was 11.2 months.Results:At the time of initial presentation, the mean age of the 24 patients was 54.1 ± 10.28 years. Macular detachment along with FS was present in all cases, whereas full-thickness macular hole-related retinal detachment was present in nine cases. Swept-source optical coherence tomography parameters showed reduction of FS with foveal reattachment in all eyes except one at last visit. Mean axial length decreased from 28.5 mm preoperatively (range 26–33.8 mm) to 26.2 mm (range 24–29.3 mm). The mean best-corrected visual acuity changed from 1.16 log MAR to 1.096 Log MAR (P = 0.165). Visual acuity improved in 10 eyes (40%), remained stable in 11 eyes (44%) and decreased in 4 eyes (16%).Conclusion:Macular buckling is a good surgical technique with encouraging anatomic and visual outcomes in patients with myopic macular detachment associated with PS. Highly selective cases of myopic traction maculopathy can have a viable option of macular buckle surgery in stabilizing the retinal tractional changes, and thereby, vision loss.

CHARACTERISTICS AND MANAGEMENT OF MYOPIC TRACTION MACULOPATHY IN MYOPIC EYES WITH AXIAL LENGTH LESS THAN 26.5 mm.

Purpose:To explore the characteristics and underlying mechanisms of myopic traction maculopathy (MTM) with axial length less than 26.5 mm and to assess the effectiveness of macular buckling for the treatment of MTM.Methods:Thirty-eight MTM eyes with axial length less than 26.5 mm were prospectively enrolled. Thirty-one eyes received surgery, and they were followed up for at least 6 months. Characteristics of MTM and surgical outcomes were evaluated.Results:Of the MTM eyes, 92.11% (35/38) showed posterior staphyloma. Narrow macular staphyloma was the most common type (54.29%, 19/35), followed by peripapillary (37.14%, 13/35). Three cases (8.57%) had wide macular staphyloma, and 44.74% of cases (17/38) had vitreoretinal traction. Twenty-two MTM eyes of type T3 underwent macular buckling surgery, and all the cases achieved foveal reattachment after the surgery. The mean best-corrected visual acuity improved significantly at the 6-month follow-up (P < 0.001). Nine MTM eyes of type T4 or T5 received combined surgery, all macular holes recovered, and the best-corrected visual acuity also improved postoperatively (P = 0.008) as of the 6-month visit.Conclusion:Posterior staphyloma might serve as the initial force of the pathogenesis of MTM in eyes with axial length ˂26.5 mm. Macular buckling is a productive way to improve the MTM.

Optic Disc Pit Maculopathy: Review of Recent Advances in Its Diagnosis and Management

Optic disc pit (ODP) is a rare congenital anomaly of the optic disc which is usually unilateral and sporadic. It can lead to visual impairment secondary to ODP maculopathy characterised by intraretinal and subretinal fluid collection at macula with no known trigger factors. We came across a case of ODP maculopathy being misdiagnosed and mistreated as chronic CSR which led us to review the advances in its diagnosis and management as ODP maculopathy left untreated carries poor prognosis. Its management remains challenging as there are no clear guidelines and multiple modalities are available. Although few cases of spontaneous resolution of maculopathy are reported in literature but current management of ODP maculopathy is surgical intervention. The most commonly performed surgery for ODP maculopathy is 23 G PPV, either alone or in combination with ILM peeling, gas tamponade or laser photocoagulation. Recent treatment modalities available are intravitreal gas tamponade, macular buckling, inner retinal fenestration, glial tissue removal and autologous fibrin. Prognosis is poor if multilayer intraretinal and subretinal fluid collection is seen on OCT while cases where fluid don’t reach to macular arcade vessels have better anatomical and visual outcomes. Even though there are many recent advances in the diagnosis and management of disease, management remains challenging as there are no comparative studies of different therapeutic modalities and their success rate, related to the anatomical and functional outcomes. This review discusses the literature on possible pathogenesis of ODP maculopathy as well as the recent advances in its diagnosis and management.

Macular buckling and pars plana vitrectomy for retinitis pigmentosa with posterior staphyloma and macular hole

We describe a case of myopic macular hole (MMH) associated with posterior pole staphyloma (PPS) and foveal detachment (FD) complicated by the presence of Retinitis Pigmentosa (RP). The patient underwent combined macular buckling (MB) and pars plana vitrectomy (PPV). Two month post-operatively, the optical coherence tomography (OCT) showed a closed macular hole with flattened posterior pole. The challenges posed by a FD due to a MMH complicated both by a PPS and RP have been elaborated. A significant anatomical and visual improvement was achieved, providing better central vision in a patient with already compromised peripheral vision.

CHANGES IN THE CHOROIDAL THICKNESS AFTER MACULAR BUCKLING IN HIGHLY MYOPIC EYES.

To assess changes in the choroidal thickness (CT) after macular buckling in eyes with high myopia. Highly myopic eyes that underwent macular buckling surgery were retrospectively analyzed. Data of swept-source optical coherence tomography scanning at baseline and at 1, 3, 6, 12, and 18 months after macular buckling were collected. Subfoveal CT and CT at 750 µm superior, inferior, nasal, and temporal to the fovea were measured. The total choroidal area, vascular area, and stromal area were measured by the binarization method. The choroidal vascularity index was calculated by dividing the vascular area by the total choroidal area. Forty-one eyes were included in the final analysis. The subfoveal CT increased from 49.85 ± 31.23 µm preoperatively to 75.74 ± 37.89 µm 1 month after macular buckling (P < 0.001), then decreased over time, coinciding with the trends of parafoveal CT, total choroidal area, vascular area, and stromal area. The subfoveal CT was restored to the preoperative level six months postoperatively (P = 0.202) and remained stable until the end of follow-up. The choroidal vascularity index increased at 1 and 3 months postoperatively (P = 0.001 and 0.005, respectively). The choroid thickened in the early postoperative period. The compression force of the buckle implant might disturb microcirculatory drainage and contribute to the thickening. The choroid spontaneously recovered to the preoperative level over time.

Diagnostic and therapeutic approaches to optic disc pit maculopathy in children

Background: Optic disc pit (ODP) is a rare congenital defect of the optic disc that can lead to maculopathy and gradual visual impairment. This review summarizes our current knowledge on the diagnostic and therapeutic approaches to ODP maculopathy (ODP-M) in children.&#x0D; Methods: A thorough literature search was performed using the PubMed/MEDLINE database from 1960 to 2020. An additional search was conducted using Google Scholar for completeness.&#x0D; Results: ODP-M is characterized by the accumulation of subretinal and/or intraretinal fluid. The exact pathogenetic mechanisms are not fully understood, and the origin of the fluid remains unknown. Although ODP-M is more likely to occur during the third or fourth decade of life, cases of children with serous retinal detachment have been recorded. Early diagnosis of ODP-M and prompt, appropriate management are crucial, particularly in patients of amblyogenic age. In adults, ODP-M may resolve spontaneously, but most cases require surgical intervention to prevent permanent loss of vision. However, the fact that ODP-M may spontaneously resolve in children cannot be ignored. Various surgical methods have been described, including pars plana vitrectomy (PPV) combined with various techniques, including laser photocoagulation, intravitreal gas injection, and macular buckling. &#x0D; Conclusions: PPV remains the mainstay surgical approach for ODP-M. However, ODP-M may differ between children and adults. Children constitute a unique population of patients that require a different and probably more tailor-made approach. Detailed clinical examination, combined with a thorough analysis of retinal imaging, may improve our understanding of the background and pathophysiology of the disease and eventually provide us with new insights into the management of ODP-M in the pediatric population.&#x0D; &#x0D; How to cite this article: Kalogeropoulos D, Asproudis I, Ch’ng SW, Mitra A, Sharma A, Katsikatsos K, Asproudis C, Kalogeropoulos C. Diagnostic and therapeutic approaches to optic disc pit maculopathy in children. Med Hypothesis Discov Innov Optom.2021 Spring; 2(1): 24-35. DOI: https://doi.org/10.51329/mehdioptometry122&#x0D;

Macular buckling for highly myopic traction maculopathy

Objective: To observe the efficacy of macular buckling in the treatment of highly myopic traction maculopathy. Methods: Retrospective case series study. The patients with high myopia who underwent macular buckling at the Zhongshan Ophthalmic Center of Sun Yat-sen University from June 2014 to June 2019 were enrolled, including 136 males and 212 females. The age was (56.68±11.59) years old. The outcomes measured included retinal reattachment rate, foveoschisis recovery rate, macular hole closure rate, postoperative best corrected visual acuity (BCVA), axial length (AL), and complications. The measurements were recorded preoperatively and at 1 month, 6 months, 1 year, 2 years, and 3 years postoperatively. The data was statistically analyzed using paired t test. Results: A total of 378 eyes were included, including 216 eyes with foveoschisis and macular detachment and 162 eyes with macular holes and macular detachment. Among them, 296 eyes underwent macular buckling, and the other 82 eyes underwent macular buckling combined with pars plana vitrectomy. During the follow-up period, 373 eyes (98.68%) achieved retinal reattachment; in patients with foveoschisis, 204 eyes (94.44%) were recovered; in patients with macular holes, 89 eyes (54.09%) achieved closure. All the postoperative results of BCVA were better than the preoperative value (1.459±0.841). BCVA continued to increase from postoperative month 1, remained stable at 1 year, and reached 0.908±0.606 at 3 years (t=6.896, P<0.01). All the postoperative results of AL were shorter than the preoperative value. The AL shortened by (4.423±1.740)mm at one month (t=33.144, P<0.01), increased gradually thereafter, remained stable at 1 year, and shortened by (2.101±1.643) mm at three years (t=6.392, P<0.01). The common complications included transient high intraocular pressure in 98 eyes (25.92%), epiretinal hemorrhage in 67 eyes (17.72%), and vitreous hemorrhage in 9 eyes (2.38%), which all resolved spontaneously within 1 month. In the early postoperative period, all patients had a certain degree of eye movement limitation, and 39 eyes (10.31%) had diplopia which resolved within 6 months without treatment. The strabismus surgery was arranged to treat esotropia in 6 eyes (1.58%). The macular buckle was removed from 1 eye (0.26%) because of the inability to tolerate diplopia. There were 8 eyes (2.11%) requiring a second operation to adjust the position of the buckle. The macular buckle was also removed from 4 eyes (1.05%) due to the implant rejection. Conclusion: Macular buckling can effectively shorten the AL, resolve posterior scleral staphyloma, and improve vision in the treatment of highly myopic traction maculopathy. (Chin J Ophthalmol, 2021, 57: 433-439).

Outcomes of macular buckling surgery in myopic foveal detachment eyes with and without disrupted ellipsoid zone band: a case-control study.

To compare the outcomes of macular buckling (MB) surgery between myopic foveal detachment (FD) eyes with and without ellipsoid zone (EZ) disruption. A retrospective, case-control study. Forty-four consecutive eyes from 44 patients received MB surgery for myopic FD between November 2017 and January 2019 were included. The eyes were divided into two groups according to the integrity of EZ on spectral-domain optical coherence tomography (SD-OCT): 28 eyes with disrupted EZ band and 16 eyes with intact EZ band. Main outcome measures were visual acuity and the duration of subfoveal fluid (SFF) after MB. The mean follow-up time was 17.64 ± 6.61 and 16.06 ± 5.78 months in the disrupted EZ and intact EZ group, respectively (P = 0.430). The logMAR best-corrected visual acuity (BCVA) improved significantly, from 1.13 ± 0.46 and 1.12 ± 0.39 at baseline to 0.85 ± 0.65 (P = 0.002) and 0.53 ± 0.33 (P = 0.000) for the disrupted EZ group and intact EZ group, respectively. The mean visual improvement was 15.00 ± 14.14 Early Treatment Diabetic Retinopathy Study (ETDRS) letters for the disrupted EZ group and 26.88 ± 19.48 ETDRS letters for the intact EZ group. Significant difference was found on both final postoperative BCVA (P = 0.035) and visual improvement (P = 0.025). At 6 months, SFF remained in 53.57% (15/28) of the eyes in the disrupted EZ group and in only 12.50% (2/16) of the eyes in the intact EZ group (P = 0.018). The intact EZ group showed better functional and anatomical outcomes than the disrupted EZ group after MB surgery.

The Role of the Outer Lamellar Macular Hole in the Surgical Management of Myopic Traction Maculopathy

Purpose: To evaluate the anatomical and functional surgical outcomes of eyes affected by myopic traction maculopathy (MTM) with and without an outer lamellar macular hole (O-LMH). Methods: Forty-eight eyes affected by MTM were included: a study group of 24 eyes with an O-LMH and a control group of 24 eyes without an O-LMH. All patients underwent spectral-domain optical coherence tomography (SD-OCT) and were staged according to the MTM staging system. The surgical techniques applied were pars plana vitrectomy (PPV), macular buckle (MB), or combined surgery. The follow-up visit was 12 months after the latest intervention. Results: Best-corrected visual acuity (BCVA) improved significantly in both groups after surgery (p < 0.05). A successful surgical result was obtained in both groups at the final follow-up. In the study group, 3 eyes underwent PPV, 14 eyes underwent MB, and 7 underwent a combined surgery. Six patients developed an iatrogenic full-thickness macular hole (FTMH). In the control group, 5 eyes underwent PPV, 16 underwent MB, and 3 had combined surgery. Four patients developed a FTMH. In both groups, all the eyes with an iatrogenic FTMH received PPV as first surgery (alone or combined). A topographical correspondence between the interruption of the ellipsoid zone (EZ) and the backscattering phenomenon was found on OCT. Conclusion: The O-LMH is an OCT sign that may occur in eyes affected by MTM. Its presence is correlated with a higher risk of developing an iatrogenic FTMH after PPV (alone or combined) probably due to the thinner residual retinal tissue. Postoperative BCVA is not limited in eyes with an O-LMH and this may be explained by the restoration of the EZ after surgery.

Macular buckling versus vitrectomy on macular hole associated macular detachment in eyes with high myopia: a randomised trial

AimTo compare the efficacy of macular buckling (MB) and pars plana vitrectomy (PPV) for full-thickness macular holes (FTMH) and associated macular detachment (MD) in highly myopic eyes.MethodsProspective interventional case series...

Myopic Traction Maculopathy: A New Perspective on Classification and Management.

Myopic traction maculopathy (MTM) is a complex disease affecting approximately 30% of eyes with pathologic myopia. A review of the history of treatment of MTM with success rates and limitations of different surgical techniques are reported.The pathogenesis, the definition and the management were clarified in a recent study(cit). The MTM Staging System (MSS) table summarizes all the stages of MTM offering insights on the pathogenesis and natural evolution of the disease.Guidelines of management of MTM were therefore proposed, but customized for each stage.Initial stages 1a and 2a, which define maculoschisis in the inner or inner-outer or only outer layers of the retina, should be observed. Stages 3a and 4a, defining macular detachment with and without associated schisis, should be treated with a macular buckle (MB).Stage 1b, which is a lamellar macular hole in a myopic eye, should be treated with pars plana vitrectomy (PPV) only in symptomatic cases. Stages 2b, 3b, and 4b should be treated with a MB and PPV should be added in a second step only if the presence of a lamellar macular hole requires intervention to improve visual function.Stage 1c, which is a full thickness macular hole in a myopic eye, should be treated with PPV. Stages 2c, 3c and 4c should be treated with a combination of simultaneous MB + PPV to treat both the retinal pattern of schisis or detachment and the full thickness macular hole.

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

Purpose:To compare morphological features of staphyloma (type and grade) with structural and functional outcomes in 11 patients with symptomatic myopic tractional maculopathy (MTM) who underwent macular buckle surgery.Methods:A retrospective observational case series, where a chart review was conducted of the type (Curtin classification) and grade of staphyloma (USG B-scan based). Optical coherence tomography (OCT) macula analysis done preoperatively and postoperatively 1 and 6–8 weeks), Visual acuity was recorded in log mar.Results:With an average myopia of −10.35 D (−5 to −14.5 D), there were four patients with types II and IX staphyloma and seven with type I staphyloma. The average axial length was 28.6 ± 0.98 mm in type II/IX and 26.2 ± 0.8 mm in type I. Preoperative OCT features were outer retinal layer schisis (11), retinal detachment (foveal: 2, macular: 8), macular hole (lamellar: 3, full thickness: 4), and taut posterior hyaloid (3). Postoperatively, patients with type II/IX staphyloma had significant gain in visual acuity from 1.05 ± 0.3 to 0.74 ± 0.2 Log Mar. The structural features also responded better in patients with types II/IX staphyloma, with all patients having more than 90% reduction in schisis and retinal attachment at 6 weeks. Whereas only two patients with type I staphyloma had similar reduction in schisis at 6 weeks and only one had complete retinal attachment.Conclusion:In patients with MTM, the staphyloma characteristics preoperatively can help us prognosticate about structural and functional success after macular buckle surgery. In our small case series, patients with type II/IX staphyloma and larger axial length had better structural and functional outcomes.

Proposal for the management of myopic traction maculopathy based on the new MTM staging system.

To propose the Myopic Traction Maculopathy (MTM) management Table, based on the MTM Staging System (MSS). A retrospective review of 157 eyes affected by MTM, operated with pars plana vitrectomy (PPV), or macular buckle (MB) or combined surgery (MB + PPV). Each case was classified according to the MSS. Anatomical results were evaluated with OCT at an intermediate follow-up (3-6 months) and at a final follow-up (2-8 years), considering changes both in the foveal and in the retinal pattern. The number and type of operations needed were noted. The surgical complications were reported. Primary surgery was MB for 83 eyes (52%), PPV for 36 (23%) and MB + PPV for 38 (24%). At intermediate follow-up, the retinal pattern was restored in 55.41% and foveal in 42.68%.Further surgery was indicated as PPV in 25.48%, MB in 14.65%. At the final follow-up, the retinal pattern was restored in 96.16% and the foveal pattern in 87.90%.BCVA improved at the final follow-up (p < 0.05). The complications of MB were not sight-threatening. The complications of PPV were FTMH in 67% cases in stages 2, 3, and 4. Cataract developed in 60% of phakic eyes. The complications of combined MB+PPV were cataract (56%) and PVR (5%). Both PPV and MB may be used to treat MTM. PPV addresses the changes in the foveal pattern while MB addresses the changes in the retinal pattern. The MTM management table offers a proposal for the choice of type and timing of treatment customized per each stage of MTM.

Outcomes of a new 3-D printing-assisted personalized macular buckle combined with para plana vitrectomy for myopic foveoschisis.

To describe and evaluate the application of a new 3-D printing-assisted personalized macular buckle for patients with myopic foveoschisis (MFS). Twelve eyes of 12 patients with MFS were included in this study. Preoperative MRI images were subsequently measured after marker implantation and imported into the MIMICS software for the 3-D reconstruction of a virtual model of an eyeball and a marker. The virtual eyeball model was designed according to the degree of retinoschisis, which was measured using optical coherence tomography preoperatively. A macular buckle was designed using a titanium stent, assisted by 3-D printing; furthermore, it was surgically placed in combination with pars plana vitrectomy. Visual acuity, axial length and anatomic outcomes were analysed pre- and postoperatively. Macular schisis in all patients was completely resolved after the surgery without any postoperative complications. The mean postoperative best corrected visual acuity (LogMAR) improved significantly from 1.21 to 0.92 during the 6-month follow-up period (p<0.001) and reached 0.9 (p<0.001) after 2years. The axial length was significantly shortened during the 2years postoperatively follow-up period (p<0.01). The average axial lengths in all patients decreased from 30.62mm preoperatively to 29.81mm 1month postoperatively and remained around 30.16mm from 1year after the surgery. The 3-D printing technique is useful to predict the indentation height and position of the macular buckle. The 3D-printing-assisted macular buckle, in combination with vitrectomy, is an effective, safe and accurate treatment modality for MFS.

Myopic Traction Maculopathy: Diagnostic and Management Strategies.

Pathologic myopia (PM) is an ocular disorder characterized by a spherical equivalent (SE) of more than – 6.0 diopters (D) or by an axial length (AL) of more than 26.5 millimeters (mm). PM is associated with myopic maculopathy (MM). The ATN classification describes all the aspects of MM which regroups atrophic, tractional and neovascular consequences to the sclera, choroid and retina of highly myopic eyes. The advent of OCT allowed to define the ultrastructural characteristics of the tractional changes in MM, described by the term myopic traction maculopathy (MTM). They include foveoschisis/maculoschisis/retinoschisis (FS/MS/RS), retinal/foveal detachment (RD/FD), lamellar macular holes (LMH) and full-thickness macular holes (FTMH) with or without RD (MHRD). The MTM staging system (MSS) describes all foveal and retinal changes related to MTM and their natural history interpreting them as different stages of a single progressive disorder. The management of MTM can be just observation for the earliest cases with good vision or surgery for the severe stages with vision loss. There are two possible surgical approaches: ab externo, that acts on the alteration of the scleral shape and includes posterior scleral reinforcement and macular buckle. Ab interno, that targets the alteration of the foveal profile and consists in pars plana vitrectomy with removal of all the epiretinal tractions, maneuvers on the internal limiting membrane, and the use of intravitreal tamponade and laser. As they target two different sides of the same pathology, the two techniques have to be selected on the base of the MTM stage, single or combined.

Individualized Ophthalmic Exoplants by Means of Reverse Engineering and 3D Printing Technologies for Treating High Myopia Complications with Macular Buckles

Myopic macular foveoschisis maculopathy is an eye disease that is treated, in most cases, with surgical intervention, in which a macular buckle is applied to restore eye anatomy and functionality. A macular buckle is a type of exoplant that comes in various designs and sizes. Often, they are difficult to apply or they do not fit properly in the eye geometry since they have a generic form. In this work, the effort to develop the most suitable tailor-made macular buckle for each individual patient for treating myopic traction maculopathy is studied. Pattern recognition techniques are applied to the patient’s Computed Tomography (CT) data to develop the exact 3D geometry of the eye. Using this 3D geometry, the trajectory of the buckle is fitted and the buckle is formed, which is then 3D-printed with biocompatible polymer materials. It is expected that the power of technology will be used to activate the most precise approach for each individual patient. Considering the possible complications and technical difficulties of other surgical methods, the customized macular buckle is an appropriate, easy-to-use, and most precise piece of medical equipment for the treatment of myopic traction maculopathy.

Retinal Detachment due to Macular Hole and Posterior Tears: Risk Factors, Pathogenesis, Clinic, and Management

Retinal detachment (RD) due to macular hole (MHRD) and posterior retinal tears are rare but also important clinical conditions in vitreoretinal daily practice. MHRD is frequently associated with high myopia and posterior staphyloma, whereas posterior tear related RD is often associated with secondary pathologies. A gold standard method or algorithm for clinical management is not yet available in such cases. Treatment options include pneumoretinopexy, pars plana vitrectomy, and tamponade injection (gas or silicone oil), epiretinal membrane, and/or internal limiting membrane (ILM), intraoperative retinal laser applications and macular buckling peeling. Each surgical method has several advantages and disadvantages. However, in recent years, successful results regarding ILM peeling and ILM flap applications and the use of high-density silicone oil (HDSO) have been reported. Furthermore, macular buckling has gained popularity again although it is a difficult procedure to perform. In conclusion, retinal detachment cases due to MH and posterior retinal tears are difficult to manage and the surgeon should determine the primary patient-specific approach for each case with minimum risk and maximum success. Prospective, randomized, and controlled trials are critically important to determine the gold standard method in these cases.

INTERNAL CHANDELIER-ASSISTED MACULAR BUCKLING FOR MYOPIC FOVEOSCHISIS.

To present a surgical technique and case presentation of internal chandelier-assisted macular buckling for myopic foveoschisis. Review of patient clinical features, visual acuity, and optical coherence tomography results after internal chandelier-assisted macular buckling for myopic foveoschisis. A 48-year-old highly myopic woman (axial length 29.85 mm) underwent internal chandelier-assisted macular buckling for myopic foveoschisis with macular detachment. The best-corrected visual acuity improved from 20/150 to 20/40. Postoperative optical coherence tomography confirmed central buckle positioning and demonstrated resolved foveoschisis and macular detachment. There were no complications. Internal chandelier-assisted macular buckling is a valuable tool to optimize buckle position and patient outcomes.

Pathogenesis and Prevention of Worsening Axial Elongation in Pathological Myopia.

PurposeThis review discusses the etiology and pathogenesis of myopia, prevention of disease progression and worsening axial elongation, and emerging myopia treatment modalities.IntroductionPediatric myopia is a public health concern that impacts young children worldwide and is associated with numerous future ocular diseases such as cataract, glaucoma, retinal detachment and other chorioretinal abnormalities. While the exact mechanism of myopia of the human eye remains obscure, several studies have reported on the role of environmental and genetic factors in the disease development.MethodsA review of literature was conducted. PubMed and Medline were searched for combinations and derivatives of the keywords including, but not limited to, “pediatric myopia”, “axial elongation”, “scleral remodeling” or “atropine.” The PubMed and Medline database search were performed for randomized control trials, systematic reviews and meta-analyses using the same keyword combinations.ResultsStudies have reported that detection of genetic correlations and modification of environmental influences may have a significant impact in myopia progression, axial elongation and future myopic ocular complications. The conventional pharmacotherapy of pediatric myopia addresses the improvement in visual acuity and prevention of amblyopia but does not affect axial elongation or myopia progression. Several studies have published varying treatments, including optical, pharmacological and surgical management, which show great promise for a more precise control of myopia and preservation of ocular health.DiscussionUnderstanding the role of factors influencing the onset and progression of pediatric myopia will facilitate the development of successful treatments, reduction of disease burden, arrest of progression and improvement in future of the management of myopia.

Macular buckle with Morin–Devin T implant for pathological myopia with macular hole

Introduction: Pathological myopia is commonly associated with myopic traction maculopathy, which includes foveoschisis, foveal retinal detachment, macular hole (MH) and/or macular detachment (MD). Macular buckling is a rarely practiced extraocular surgical modality these days. The purpose of this study was to investigate the efficacy of primary buckling with Morin–Devin T implant for MD with MH and posterior staphyloma.&#x0D; Case description: A 52-year-old female presented with light perception vision in her right eye with posterior staphyloma, localized neurosensory detachment, and MH. She underwent primary macular buckling with Morin–Devin T implant. During the immediate postoperative day the wedge indentation was found misaligned to the fovea. A revision surgery was done after 2 weeks for repositioning of the macular wedge. Spectral domain optical coherence tomography confirmed indentation at the MH with resolution of subretinal fluid and hole closure. Her BCVA was 2/60 at 3 months postoperative and it remained the same even at 6 months of follow-up.&#x0D; Conclusions: Primary macular buckling can be an effective procedure in eyes with MH with detachment and posterior staphyloma with or without associated foveoschisis. Morin–Devin T implant placement is a relatively simple procedure with short surgical time and excellent outcome.