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Park, Kim, Ha, and Kang: The Macular Buckling Procedure for Retinal Detachment Associated with a Macular Hole in High Myopia
Original Article
Journal of the Korean Ophthalmological Society

Journal of the Korean Ophthalmological Society 2012; 53(7): 969-976.

Published online: 13 July 2012

DOI: https://doi.org/10.3341/jkos.2012.53.7.969

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

Do Young Park, MD, Jae Hui Kim, MD, Hyo Shin Ha, MD, Se Woong Kang, MD

Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

Address reprint requests to Se Woong Kang, MD. Department of Ophthalmology, Samsung Medical Center, #81 Irwon-ro, Gangnam-gu, Seoul 135-710, Korea. Tel: 82-2-3410-3562, Fax: 82-2-3410-0074, swkang@skku.edu

Received 19 September 2011       Accepted 8 June 2012

Copyright © 2012 The Korean Ophthalmological Society

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.

Keywords: Macular buckle, Macular hole, Retinal detachment

Figures and Tables

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.
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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.
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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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Table 1
Preoperative clinical characteristics and postoperative results
jkos-53-969-i001

RD = retinal detachment; MH = macular hole; OCT = optical coherence tomography.

*Not available; †Total retinal detachment; ‡Retinal detachment confined to the posterior staphyloma.

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