Advantages:

Myopic traction maculopathy (MTM), also known as myopic foveoschisis, describes the schisis-like thickening in the outer layers of highly myopic eyes with posterior staphyloma. Other findings may also include inner retinal fluid, foveal detachment, and lamellar or full-thickness macular holes followed by progressive retinal detachment. Suprachoroidal buckling (SCB) procedure is a new approach for treating MTM by creating suprachoroidal indentation. A specially designed catheter is guided in the suprachoroidal space and hyaluronic acid is injected to indent the choroid in the target area creating SCB, thereby supporting the overlying retina. This effect restores the normal contour of the choroid or even indents it to a convex configuration supporting the retina. SCB may be used alone or in conjunction with pars plana vitrectomy (PPV).

Methods:

We describe the cases of two high myopic patients, one with macular hole associated with shallow posterior pole detachment and another with myopic foveoschisis and macular hole. In both, standard 3-port, 23-gauge PPV and dissection of the posterior hyaloid was performed. A suprachoroidal catheter with illuminated tip was used to deliver stabilized long-acting hyaluronic acid as a filler in the suprachoroidal space in the area of the staphyloma forming a choroidal indenting effect. Clinical and optical coherence tomographic evaluations of these patients were performed over 1-year follow-up. We observed closure of the hole in both patients and resolution of the detachment in the first. Visual acuity improved from 0.05 to 0.1 in both patients.

Effectiveness/Safety:

The indentation effect achieved by suprachoroidal approach can be used as a method of managing myopic foveoschisis and myopic macular hole with detachment, counteracting the role of posterior staphyloma in the progression of the disease. The indentation effect seemed sufficient for the first year of follow-up. There were no ischemic changes, possibly due to the gentle sloping elevation created via the suprachoroidal approach, which may have created less mechanical pressure and effects on the choroidal circulation compared with conventional episcleral macular buckling. SCB with or without PPV may be a promising less invasive treatment option for MTMs.