Barbara Parolini, Grazia Pertile* (Verona, Italy)

Advantages:

Macular detachment in high myopia is a challenge for the surgeon. Various surgical approaches have been tried in the past years with frequent disappointment either for the rare success or for the difficult surgical strategy. Macular buckle, combined with the relieve of vitreoretinal traction through vitrectomy, may guarantee a higher anatomic success rate than the endobulbar approach alone, but it has been abandoned for the awkward technique required to place it. A recent design of macular buckle allows for anterior suturing and it is therefore easier to use.

Methods:

A recent design of macular buckle, made of silicone and titanium, can be molded and placed through the superotemporal quadrant and sutured anteriorly at the level of the muscle insertion. The exact position of the buckle is selected during the vitrectomy procedure by looking directly through the BIOM. Twenty-nine patients were operated with vitrectomy, ILM peeling and macular buckle. A follow up of at least 6 months is reported.

Effectiveness / Safety:

The macular buckle combined with vitrectomy is an effective procedure to treat macular detachment in high myopia. The rate of redetachment is lower with combined vitrectomy compared with the rate of redetachment after vitrectomy and ILM peeling alone, reported in literature and by the author’s experience.

Take home message:

I propose combined vitrectomy, ILM peeling and macular buckle macular detachment in high myopia. Comment: the possibility of extending this procedure to myopic retinoschisis without detachment will be presented and discussed.