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A New L-Shaped Design of Macular Buckle to Support a Posterior Staphyloma in High Myopia

A New L-Shaped Design of Macular Buckle to Support a Posterior Staphyloma in High Myopia Macular foveoschisis, macular detachment (MD) without macular hole, and macular detachment with macular hole could be different stages of a progressive disease well described as myopic traction maculopathy. The pathogenesis and natural history of myopic traction maculopathy are still uncertain, and the best management is debated. Elimination of epiretinal tractions by means of vitrectomy with or without internal limiting membrane peeling seems an acceptable approach and has proven to be effective. Vitrectomy alone, however, causes a transient release of the traction without addressing the major risk factor of the macular foveoschisis, which is the posterior staphyloma. Furthermore, it should be noted that vitrectomy with internal limiting membrane peeling, in highly myopic eyes, may lead to complications, such as macular hole formation, extrafoveal retinal hole formation, or physiologic changes in the macular area. To give a new shape to the posterior scleral wall, the issue of the posterior staphyloma, by the use of a scleral buckle alone, has been previously reported with good anatomical and functional results. The authors of this article think that an L-shaped buckle design (see Video, Supplemental Digital Content; http://links.lww.com/IAE/A158) is the easiest to place and leads to the lowest risk of intraoperative and postoperative complications. However, it has been used always in combination with vitrectomy. Besides, the newest designs of macular buckle (by Ando and by Stirpe) are not widely available on the market. The present study has a dual purpose. First, we aimed to study the role of the macular buckle alone, in releasing the anteroposterior and tangential tractions of macular foveoschisis, in cases of MD not associated to macular hole. Second, we wanted to test the feasibility, tolerability, and safety of a new L-shaped buckle, which can be made in the operating room.