Pathologic Myopia Research Articles

A Novel Technique Using Lyophilized Amniotic Membrane Patch (LAMPatch) as Primary Procedure in Patients with Myopic Traction Maculopathy with Macular Detachment.

Maculopathy secondary to pathologic myopia (PM) is increasingly causing visual impairment and blindness worldwide. PM is associated with tractional maculopathy that ranges from macular foveoschisis to macular hole. These disorders are treated with different options that offer variable results, reflecting the need for new techniques that address myopic maculopathy with consistent outcomes. Since human amniotic membrane (HAM) has been reported to be safe for intraocular use and to promote retinal healing, it was incorporated as an adjuvant in pars plana vitrectomy in patients with different tractional disorders related to myopia. This work presents a prospective, consecutive case series of seven patients with high myopia who underwent a 25-gauge vitrectomy with ILM peeling and HAM transplantation. Our six-month results show that this novel technique delivers functional success related to tissue permanence without recurrence of traction that translates into visual acuity gain and maintenance that are superior to other techniques.

Posterior scleral reinforcement surgery effectively slows the rate of high myopic progression in children

To investigate the rate of axial length elongation and high myopia progression in operated eyes before and after posterior scleral reinforcement (PSR) surgery. This was a retrospective study. Children with pathological myopia treated with PSR at Beijing Tongren Hospital between May 2013 and May 2020 were recruited into the PSR surgery group. Children matched for age and myopia were recruited into the control group. All children underwent comprehensive ophthalmologic examinations. The presurgical and postsurgical rates of axial length elongation and myopic (spherical equivalent) progression were calculated. A total of 35 PSR patients were included in the study. The mean age was 6.5±3.0years (range 2 to 14years). Mean follow-up was 544days (range 216 to 1657days). The rate of axial length elongation was significantly less after posterior scleral reinforcement surgery (0.505±0.048mm per year prior to surgery; 0.382±0.045mm per year after surgery, P<0.001). The rate of myopic progression decreased after posterior scleral reinforcement surgery (1.162±0.118D per year prior to surgery; 0.153±0.437D per year after surgery, P=0.0239). There was no statistically significant difference in axial length elongation or myopic progression between pre-inclusion and post-inclusion in the control group. Moreover, the children's best-corrected visual acuity was significantly improved after posterior scleral reinforcement surgery (P<0.001). Posterior scleral reinforcement surgery effectively decreased the rate of high myopic progression and axial length elongation in children.

Genome-Wide Association Analysis Identifies LILRB2 Gene for Pathological Myopia.

Pathological myopia (PM) is one of the leading causes of blindness, especially in Asia. To identify the genetic risk factors of PM, a two-stage genome-wide association study (GWAS) and replication analysis in East Asian populations is conducted. The analysis identified LILRB2 in 19q13.42 as a new candidate locus for PM. The increased protein expression of LILRB2/Pirb (mouse orthologous protein) in PM patients and myopia mouse models is validated. It is further revealed that the increase in LILRB2/Pirb promoted fatty acid synthesis and lipid accumulation, leading to the destruction of choroidal function and the development of PM. This study revealed the association between LILRB2 and PM, uncovering the molecular mechanism of lipid metabolism disorders leading to the pathogenesis of PM due to LILRB2 upregulation.

Historical and practical aspects of macular buckle surgery in the treatment of myopic tractional maculopathy: case series and literature review

BackgroundUncorrected myopia is a leading cause of blindness globally, with a rising prevalence in recent decades. Pathological myopia, often seen in individuals with increased axial length (AXL), can result in severe structural changes in the posterior pole, including myopic tractional maculopathy (MTM). MTM arises from tractional forces at the vitreoretinal interface, leading to progressive macular retinoschisis, macular holes, and retinal detachment (RD). This study aims to outline preoperative evaluation and surgical indication criteria for MTM, based on the MTM staging system, and to share our Brazilian experience with three cases of macular buckle (MB) surgery, all with over a year of follow-up.MethodsWe conducted a retrospective analysis of three cases of MTM-associated RD treated with MB surgery, with or without pars plana vitrectomy. Preoperative evaluations included optical coherence tomography (OCT) and ultrasonography (USG) to assess the extent of macular involvement and retinal detachment. Surgical indications were determined based on the MTM staging system. The MB was assembled using customizable and accessible materials. Surgical procedures varied according to the specific needs of each case. An informed consent form regarding the surgical procedure was appropriately obtained for each case. The study was conducted with the proper approval of the institution’s ethics committee.ResultsAll three cases demonstrated successful retinal attachment during the mean follow-up of eighteen months. In the first case, combined phacoemulsification, vitrectomy, and MB were performed for MTM with macular hole and RD. The second case required MB and vitrectomy after two failed RD surgeries. In the third case, a macular detachment with an internal lamellar hole was treated with MB alone. These cases highlight the efficacy of MB surgery in managing MTM in highly myopic eyes.ConclusionsMB surgery is an effective treatment option for MTM-associated RD in highly myopic eyes, providing long-term retinal attachment. Our experience demonstrates that with proper preoperative evaluation and surgical planning, MB can be successfully implemented using accessible materials, offering a viable solution in resource-limited settings. Further studies with larger sample sizes are warranted to validate these findings and refine surgical techniques.

Smartphone App to Detect Pathological Myopia Using Spatial Attention and Squeeze‐Excitation Network as a Classifier and Segmentation Encoder

ABSTRACTPathological myopia (PM) is a worldwide visual health concern that can cause irreversible vision impairment. It affects up to 20 crore population, causing social and economic burdens. Initial screening of PM using computer‐aided diagnosis (CAD) can prevent loss of time and finances for intricate treatments later on. Current research works utilizes complex models that are too resource‐intensive or lack explanations behind the categorizations. To emphasize the significance of artificial intelligence for the ophthalmic usage and address the limitations of the current studies, we have designed a mobile‐compatible application for smartphone users to detect PM. For this purpose, we have developed a lightweight model, using the enhanced MobileNetV3 architecture integrated with spatial attention (SA) and squeeze‐excitation (SE) modules to effectively capture lesion location and channel features. To demonstrate its robustness, the model is tested against three heterogeneous datasets namely PALM, RFMID, and ODIR reporting the area under curve (AUC) score of 0.9983, 0.95, and 0.94, respectively. In order to support PM categorization and demonstrate its correlation with the associated lesions, we have segmented different forms of PM lesion atrophy, which gave us intersection over union (IOU) scores of 0.96 and fscore of 0.97 using the same SA+SE inclusive MobileNetV3 as an encoder. This lesion segmentation can aid ophthalmologists in further analysis and treatment. The optimized and explainable model version is calibrated to develop the smartphone application, which can identify fundus image as PM or normal vision. This app is appropriate for ophthalmologists seeking second opinions or by rural general practitioners to refer PM cases to specialists.

Exploration of Choroidal Thinning Located Temporal to the Fovea: A Pilot Study.

Background/Objectives: Posterior staphyloma (PS) is a hallmark of pathological myopia, corresponding to a circumscribed outpouching of the eyeball with choroidal thinning and inward scleral deformation at its edges. Its pathogenesis is still unclear, thus constituting a research priority as the prevalence of myopia is increasing worldwide. Recently, it has been suggested that the optic nerve sheaths or oblique muscles are potential promoters of PS through the traction or compression effect that they apply to the eye wall. The inferior oblique muscle (IOM) inserts 1-2 mm from the macula. The projection of its insertion is accessible using Optical Coherence Tomography (OCT). Before launching prospective studies, we sought to detect any choroidal thinning (ChT) in the temporal vicinity of the macula and to measure the distance between it and the fovea (FT-distance). Methods: This retrospective cross-sectional pilot study included 120 eyes. Using Spectralis®-OCT, the area centered by the Bruch's membrane opening-fovea axis was analyzed for ChT and FT-distance. Results: Of the 112 defined eyes, 70% (78 eyes) had ChT. Pachymetry was significantly thinner (p = 0.018) in eyes with than without ChT. The mean FT-distance was 3601.9 ± 93.6 µm. Conclusions: The location of ChT coincided with the insertion distance of the IOM, suggesting a link between them. The association between the presence of ChT and a thinner pachymetry suggests a reduced scleral resistance, as a thinner pachymetry is related to a thinner sclera. Our results suggest a link between ocular deformation and the IOM, which may be relevant for the pathogenesis of PS, warranting further investigation.

Unmasking of molecular players: proteomic profiling of vitreous humor in pathologic myopia

BackgroundThis study aimed to identify the differentially expressed proteins in the vitreous humor (VH) of eyes with and without pathologic myopia (PM), providing insights into the molecular pathogenesis.MethodsA cross-sectional, observational study was conducted. VH samples were collected from patients undergoing vitrectomy for idiopathic epiretinal membrane (ERM), macular hole (MH), or myopic retinoschisis (MRS). Label-free quantitative proteomic analysis identified differential protein expression, with validation using ELISA.ResultsThe proteomic profiling revealed significantly higher expressions of tubulin alpha 1a (TUBA1A) and eukaryotic translation elongation factor 1 alpha 1 (EEF1A1) in PM groups (MH-PM, MRS-PM) compared to controls (MH, ERM). Conversely, xylosyltransferase 1 (XYLT1), versican core protein (VCAN), and testican-2 (SPOCK2) expressions were lower in PM. ELISA validation confirmed these findings.ConclusionsOur study provides novel insights into the molecular mechanisms of PM. The differentially expressed proteins EEF1A1, TUBA1A, XYLT1, VCAN, and SPOCK2 may play crucial roles in chorioretinal cell apoptosis, scleral extracellular matrix (ECM) synthesis, and scleral remodeling in PM. These proteins represent potential new targets for therapeutic intervention in PM, highlighting the importance of further investigations to elucidate their functions and underlying mechanisms in disease pathogenesis.

Multi-class classification of pathological myopia based on fundus photography

Pathological myopia (PM) is a severe ocular disease leading to blindness. As a traditional noninvasive diagnostic method, fundus color photography (FCP) is widely used in detecting PM due to its high fidelity and precision. However, manual examination of fundus photographs for PM is time-consuming and prone to high error rates. Existing automated detection technologies have yet to study the detailed classification in diagnosing different stages of PM lesions. In this paper, we proposed an intelligent system which utilized Resnet101 technology to multi-categorically diagnose PM by classifying FCPs with different stages of lesions. The system subdivided different stages of PM into eight subcategories, aiming to enhance the precision and efficiency of the diagnostic process. It achieved an average accuracy rate of 98.86% in detection of PM, with an area under the curve (AUC) of 98.96%. For the eight subcategories of PM, the detection accuracy reached 99.63%, with an AUC of 99.98%. Compared with other widely used multi-class models such as VGG16, Vision Transformer (VIT), EfficientNet, this system demonstrates higher accuracy and AUC. This artificial intelligence system is designed to be easily integrated into existing clinical diagnostic tools, providing an efficient solution for large-scale PM screening.

Scleral imbrication with vitreoretinal surgery as a primary procedure for retinal detachment in pathological myopia.

A 45-year-old male presented with diminution of vision in the right eye (RE) for the past 2 weeks. He underwent sequential bilateral cataract surgery 25 years ago, with an intraocular lens in RE, which was his better eye. The left eye was aphakic with a thick fibrous membrane at the pupillary plane. Visual acuity was hand movement in the RE with the iris claw lens and total bullous retinal detachment (RD). The axial length with RD was 28.6 mm in RE and 29 mm in the left eye (LE). We did a vitrectomy with scleral imbrication, endolaser, fluid gas exchange, and tamponade in the RE. The LE developed RD subsequently, and he underwent similar surgical procedures in his LE. The best corrected visual acuity in his RE was 20/80, and that in the LE was 20/120 on follow-up. RD with staphyloma is a surgical challenge as the thin atrophic retina at the posterior pole fails to conform to the concavity of staphyloma. Vitrectomy with tamponade alone does not take care of staphyloma and has more chances of recurrent detachment or persistent fluid at the posterior pole. Scleral imbrication shallows the staphyloma cavity and shortens the axial length, thereby giving a good surgical outcome.

Lacquer cracks in pathological myopia: a clinical review.

Lacquer cracks, described as breaks in the Bruch's membrane, are unique lesions in the spectrum of fundus changes associated with pathological myopia. Lacquer cracks are generally believed to be relatively innocuous lesions by themselves; however, progression to other features of myopic macular degeneration, such as patchy chorioretinal atrophy and choroidal neovascularization, may result in irreversible visual impairment. With the rising prevalence of pathological myopia to epidemic proportions, particularly in the Asian countries, ophthalmologists expect to encounter lacquer cracks more frequently in clinical practice. Therefore, it is crucial for the ophthalmic community to be aware of lacquer cracks and to actively look for these lesions in myopic patients so that early detection and close monitoring can help prevent blinding complications. This article provides a comprehensive review on lacquer cracks in eyes with pathological myopia from a clinical perspective.

Choroidal vascular changes in early-stage myopic maculopathy from deep learning choroidal analysis: a hospital-based SS-OCT study

BackgroundThe objective of this study is to illustrate the changes in the choroidal vasculature in individuals with diffuse chorioretinal atrophy (DCA, early-stage myopic maculopathy) and investigate the association between them.MethodsThis study included 1418 highly myopic eyes from 720 participants aged 18 − 60 years from the Wenzhou High Myopia Cohort Study. These participants underwent comprehensive ophthalmic assessments. Myopic maculopathy classification followed the Meta-PM system, with pathological myopia defined as myopic maculopathy of DCA or severer. Eyes with myopic maculopathy categorized as no macular lesions (C0), tessellated fundus (C1), and DCA (C2) were enrolled in the analysis. Choroidal images were obtained from swept-source optical coherence tomography (SS-OCT), and the images were processed with a deep learning-based automatic segmentation algorithm and the Niblack auto-local threshold algorithm.ResultsDCA was detected in 247 eyes (17.4%). In comparison to eyes with C0, those with C2 exhibited significant reductions in choroidal thickness (ChT), luminal area (LA), and stromal area (SA) across all evaluated regions (all P < 0.001). An increase in choroidal vascular index (CVI) was observed in all regions, except for the nasal perifoveal (N2) and inferior perifoveal (I2) regions (all P < 0.01). Multivariable logistic regression analysis revealed a negative association between the presence of DCA and increases in choroidal LA and SA (odds ratio ≤ 0.099, P < 0.001). Multivariable linear regression analysis showed that the mean deviation of the visual field test was positively associated with LA and SA at the vertical meridian (B = 1.512, P < 0.001 for LA; B = 1.956, P < 0.001 for SA). Furthermore, the receiver operating characteristic curve analyses showed the optimal ChT to diagnose pathological myopia was 82.4 µm in the N2 region, the LA was 0.076 mm2 and the SA was 0.049 mm2, with area under the curves of 0.916, 0.908, and 0.895, respectively.ConclusionsThe results of this study indicated that both the presence of DCA and visual function impairment were associated with reductions in choroidal perfusion and stromal components. Moreover, we established threshold values for choroidal parameters in diagnosing pathological myopia, offering valuable references for clinical diagnosis and management.

Choroidal Vascularity and Axial Length Elongation in Highly Myopic Children: A 2-Year Longitudinal Investigation.

To examine the influence of subfoveal choroidal thickness (SFCT) and choroidal vascularity index (CVI) on axial length (AL) elongation over a 2-year period in highly myopic children. In this is prospective, longitudinal, observational study, 163 participants (74%), who were 8 to 18years of age with bilateral high myopia (sphere ≤ -6.0 D) and without pathologic myopia, completed follow-up visits over 2years. All participants underwent baseline and follow-up ocular examinations, including swept-source optical coherence tomography (SS-OCT) and AL measurements. SFCT and CVI were derived from SS-OCT scans using a deep-learning-based program for choroidal structure assessment. The mean age of the participants at baseline was 15.0years (±2.3), with males constituting 47% of the cohort. An inverse relationship was observed between AL elongation and increases in baseline age, baseline SFCT, and CVI, as well as a decrease in baseline AL. Adjusting for other factors, every 10-µm increase in SFCT and each 1% increase in CVI were associated with decreases in AL elongation of 0.007mm (95% confidence interval [CI], -0.013 to -0.002; P = 0.011) and 0.010mm (95% CI, -0.019 to 0.000; P = 0.050), respectively. The incorporation of SFCT or CVI into predictive models improved discrimination over models using only age, gender, and baseline AL (both P < 0.05, likelihood ratio test). Our findings suggest a possible association between a thinner choroid and increased AL elongation over 2 years in children with high myopia, after adjusting for potential baseline risk factors such as age, gender, and initial AL.

Choroidal thinning in myopia is associated with axial elongation and severity of myopic maculopathy

High myopia can lead to pathologic myopia and visual impairment, whereas its causes are unclear. We retrospectively researched high myopia cases from patient records to investigate the association between axial elongation and myopic maculopathy. Sixty-four eyes were examined in patients who visited the department between July 2017 and June 2018, had an axial length of 26 mm or more, underwent fundus photography, and had their axial length measured twice or more. The average axial length was 28.29 ± 1.69 mm (mean ± standard deviation). The average age was 58.3 ± 14.4 years old. Myopic maculopathy was categorized as mild (grades 0 and 1) and severe (grades 2, 3, and 4). The severe group had longer axial lengths than the mild group (P < 0.05). Moreover, the severe group exhibited thinner choroidal thickness than the mild group (P < 0.05). When subjects were grouped by axial elongation over median value within a year, the elongation group showed thinner central choroidal thickness than the non-elongation group (142.1 ± 91.9 vs. 82.9 ± 69.8, P < 0.05). In conclusion, in patients with high myopia, the severity of maculopathy correlated with choroidal thickness and axial length. Thinner choroidal thickness was associated with axial elongation based on the baseline axial length.

Characteristics of myopic maculopathy in Chinese children and adolescents with high myopia

AimsTo investigate the characteristics of myopic maculopathy among highly myopic Chinese children and adolescents and explore its associated risk factors.MethodsChildren and adolescents aged 7–17 years with spherical equivalent (SE) ≤...

Autologous Tenon's capsule graft for the management of subfoveal detachment due to myopic paracentral macular break.

To report a novel surgical technique using an autologous Tenon capsule graft (ATG) after vitrectomy for treating paracentral breaks in pathological myopia. A single case report of a patient with incipient subfoveal detachment and a paracentral break. Pars plana vitrectomy was performed, and next, an ATG was harvested and tucked into the break, followed by final air endotamponade. After only two days, the ATG effectively plugged the paracentral break and optical coherence tomography demonstrated complete resolution of foveoschisis and subfoveal detachment. The ATG plug offers a promising alternative for the management of paracentral breaks in eyes with pathological myopia, especially those refractory or secondary to previous surgeries. Further studies will be necessary to evaluate its long-term outcomes and safety.

The Importance of the Type of Posterior Staphyloma in the Development of Myopic Maculopathy.

The objective of this paper was to determine how different types of posterior staphyloma (PS) may affect the appearance and degree of myopic maculopathy. A cross-sectional study was conducted, in which 467 eyes from 246 highly myopic patients [axial length (AL) ≥ 26 mm] were studied. A complete ophthalmic exploration was carried out on all patients, including imaging tests. The presence of macular PS was established as the main comparison variable between groups (macular PS vs. non-macular PS vs. non-PS). The variables analyzed included age, AL, decimal best-corrected visual acuity (BCVA), Atrophy (A)/Traction (T)/Neovascularization (N) components according to the ATN grading system, and the presence of severe pathologic myopia (PM). Out of the total, 179 eyes (38.3%) presented macular PS, 146 eyes presented non-macular PS (31.2%), and 142 eyes showed no PS (30.4%). The group without PS was significantly younger than macular PS and non-macular PS groups (53.85 vs. 66.57 vs. 65.20 years; p < 0.001 each, respectively). There were no age differences between PS groups. Eyes with macular PS (31.47 ± 2.30 mm) were significantly longer than those with non-macular PS (28.68 ± 1.78 mm, p < 0.001) and those without PS (27.47 ± 1.34 mm, p < 0.001). BCVA was significantly better in the non-PS group (0.75 ± 0.27) compared to the non-macular PS (0.56 ± 0.31) and macular PS groups (0.43 ± 0.33), with p < 0.001 each. Eyes without PS showed significantly lower A and T components (1.31 ± 0.96 and 0.30 ± 0.53, respectively) than non-macular PS (2.21 ± 0.75 and 0.71 ± 0.99, respectively, p < 0.001 each) and macular PS eyes (2.83 ± 0.64 and 1.11 ± 1.10, respectively, p < 0.001 each). The N component was lower in non-PS eyes vs. non-macular PS eyes (0.20 ± 0.59 vs. 0.47 ± 0.83, p < 0.001) and as compared to the macular PS group (0.68 ± 0.90, p < 0.01). Additionally, the N component was significantly lower in the non-macular PS group than in the macular PS one (p < 0.05). The prevalence of severe PM was different between groups (p < 0.001). It was higher among macular PS eyes (138/179) when compared to other groups (p < 0.001, each), followed by the non-macular PS eyes (40/146) and being the lowest in the non-PS group (20/142). To conclude, macular PS is associated with a more advanced maculopathy, worse vision, and higher rates of severe PM.

Deep learning-based image quality assessment for optical coherence tomography macular scans: a multicentre study

AimsTo develop and externally test deep learning (DL) models for assessing the image quality of three-dimensional (3D) macular scans from Cirrus and Spectralis optical coherence tomography devices.MethodsWe retrospectively collected two...

A Method for Ocular Disease Diagnosis through Visual Prediction Explainability

Ocular diseases can range in severity, with some being more serious than others. As a matter of fact, there are several common and severe eye diseases, for instance, glaucoma, i.e., a group of eye conditions that damage the optic nerve, often associated with elevated intraocular pressure. Effective management and prevention strategies require a multifaceted approach, involving healthcare providers, public health officials and community education. Regular screenings and early interventions are crucial in reducing the impact of eye diseases on individuals and populations. In this paper, we propose a method aimed to detect the presence of ocular disease from the automatic analysis of eye fundus photographs. We consider deep learning; in detail, we adopt several convolutional neural networks aimed to train several models to be able to discriminate between different eye diseases. Furthermore, to boost the application of deep learning in real-world everyday medical practice, we adopt a method to understand which areas of the images are of interest from the model’s point of view; this allows us to detect disease by providing in this way disease localization by explainability. In the experimental analysis, we provide a set of four different experiments: in the first one, we propose a model to discern between age-related macular degenerations and normal fundus (obtaining an accuracy of 0.91); in the second one, the model is able to discriminate between cataract and normal fundus (obtaining an accuracy of 0.92); the third experiment is related to a model aimed to discriminate between glaucoma and normal ocular fundus (obtaining an accuracy of 0.88); and the last experiment is related to a model aimed to discern between pathological myopia and normal ocular fundus (obtaining an accuracy of 0.95). Thus, the experimental analysis confirms the effectiveness of the proposed method from a quantitative point of view (analysis aimed at understanding whether the model is able to correctly identify the disease) but also from a qualitative one, with a detailed and reasoned analysis aimed at understanding whether the model is able to correctly localize the disease.

Role of Optical Coherence Tomography (OCT), Fundus Photography, and Amsler Grid in Detection of Macular Disorders Associated with High Myopia

Abstract Background High myopia refers to ametropia characterized by elongation of optic axis and retinal and choroidal degeneration in the fundus, and high myopic patients present with various degrees of structural and functional retinal changes and thinning of the retinal thickness. Active screening for high myopic patients with imaging techniques by OCT, Fundus photography and amsler grid and providing patients with corresponding treatment on this basis may effectively reduce the risk of irreversible visual function damage. Objective To point to the importance of combining OCT, fundus photography with amsler grid testing in patients with high myopia. Methods This study was conducted on 40 eyes from EI-Demerdash Hospital outpatient clinic and ophthalmology department investigations unit in the period from June 2021 till May 2022; the patients were 24 females (60.0%) and 16 males (40.0%) with age ranged from 16 to 50 years. Results Our investigations gave us an idea about the macular diseases associated with high myopia and the importance of combining use of OCT, fundus imaging and amsler grid with patients with high myopia. These findings consist of chorioretinal atrophy, foveoschisis, choroidal neovascularization, dehiscence of retinal layers known as retinoschisis (foveoschisis or extre foveoschisis), macular holes (lamellar and full thickness), posterior retinal detachment. We can early detect theses changes in macula of highly myopic patients by Amsler grid testing as daily self monitoring and this can be useful in directing the patient to more sophisticated investigation tool like OCT and fundus photography and therefore give the patient the optimal chance to save the vision. Conclusion OCT combined with fundus photography and amsler grid testing are helpful tools that allow detailed evaluation of the macula in eyes with pathological myopia and easily anticipate, diagnose and follow up diseases associated with high myopia.

A New Model of a Macular Buckle and a Refined Surgical Technique for the Treatment of Myopic Traction Maculopathy.

Myopic traction maculopathy (MTM) affects 20% of eyes with pathologic myopia (PM). The MTM Staging System (MSS), published in 2020, describes the nomenclature of MTM as well as a proposal of pathogenesis, natural evolution, and prognosis. A study of customized treatment for each stage of MTM has been published previously and suggested to treat maculoschisis and detachment by placing a macular buckle (MB) behind the macula to push the sclera towards the retina, selecting pars plana vitrectomy (PPV) only in cases where a macular hole is associated with MTM. We hereby describe a new model of a macular buckle, known as NPB, and an NPB loading device, with the aim to standardize the surgical technique and render it more user friendly, efficient, and safe. Macular buckle is an effective and safe procedure to treat maculoschisis and macular detachment in MTM. We recommend using it as a unique and first-line treatment.