Four-year outcomes of macular buckling for traction maculopathy in highly myopic eyes_Chinese Journal of Ocular Fundus Diseases

Authors：

Song Huiying , Liu Bingqian , Ma Wei , Zhao Xiujuan ,  Lyu Lin

State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou 510060, ChinaZhao Xiujuan and Lyu Lin are contributed equally to the article;

Corresponding author：

Lyu Lin, Email: lulin888@126.com

Keywords：

Myopia, degenerative; Macular foveoschisis; Macular hole; Macular buckling

DOI：

10.3760/cma.j.cn511434-20220418-00222

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective To observe the long-term efficacy and safety of macular buckling (MB) in the treatment of high myopia traction maculopathy. Methods A retrospective clinical study. From January 2014 to December 2017, 57 eyes of 57 patients with high myopia traction maculopathy who underwent MB treatment at Zhongshan Ophthalmic Center of Sun Yat-sen University were included in the study. Among them, there were 15 males with 15 eyes, average age was 51.80±10.72 years; there were 42 females with 42 eyes, average age was 59.14±11.51 years. There were 21 eyes of 21 cases with highly myopic macular hole with macular detachment (MHMD), and 36 eyes in 36 cases with highly myopic foveoschisis with macular detachment (FSMD), and they were grouped accordingly. All patients underwent best corrected visual acuity (BCVA), optical coherence tomography (OCT), and axial length (AL) measurements. The standard logarithmic visual acuity chart was used for BCVA examination, which was converted into logarithm of the minimum angle of resolution (logMAR) visual acuity during statistics. All patients underwent MB, either on its own or combined with vitrectomy. Patients with significant vitreous macular traction on OCT were treated with combined surgery. One, 3, 6 months and 1, 2, 3, and 4 years after the operation, the same equipment and methods before the operation were used to conduct related examinations, and the long-term efficacy and safety of the two groups of eyes were observed. Results Before surgery, the logMAR BCVA of eyes in MHMD group and FSMD group were 1.35±0.47 and 1.17±0.59, respectively; 4 years after surgery, they were 1.02±0.49 and 0.73±0.55, respectively. The BCVA improved significantly at postoperative 4 years than preoperative in both groups (P=0.039, 0.001). In the eyes with MHMD, the BCVA was found to be significant improved 3 years after surgery (P=0.042). Whereas, in the eyes with FSMD, the BCVA was found to be significantly improved 3 months after surgery (P=0.013). Macular reattachment was achieved in 100% of cases, while macular hole closure rate was achieved in 66.7% in the MHMD group. In the FSMD group, either macular reattachment rate or the foveoschisis resolution rate was 97.2%. After surgery, choroidal neovascularization was observed in 2 eyes, and 3 eyes with intraretinal cyst. Conclusion MB may represent a safe and effective surgical option for the treatment of high myopia maculopathy.

Citation： Song Huiying, Liu Bingqian, Ma Wei, Zhao Xiujuan, Lyu Lin. Four-year outcomes of macular buckling for traction maculopathy in highly myopic eyes. Chinese Journal of Ocular Fundus Diseases, 2022, 38(6): 503-509. doi: 10.3760/cma.j.cn511434-20220418-00222 Copy

1.	Ruiz-Medrano J, Montero JA, Flores-Moreno I, et al. Myopic maculopathy: current status and proposal for a new classification and grading system (ATN)[J]. Prog Retin Eye Res, 2019, 69: 80-115. DOI: 10.1016/j.preteyeres.2018.10.005.
2.	Ohno-Matsui K, Wu PC, Yamashiro K, et al. IMI pathologic myopia[J/OL]. Invest Ophthalmol Vis Sci, 2021, 62(5): 5[2021-06-01]. https://pubmed.ncbi.nlm.nih.gov/33909033/. DOI: 10.1167/iovs.62.5.5.
3.	Kadonosono K, Yazama F, Itoh N, et al. Treatment of retinal detachment resulting from myopic macular hole with internal limiting membrane removal[J]. Am J Ophthalmol, 2001, 131(2): 203-207. DOI: 10.1016/s0002-9394(00)00728-5.
4.	Kuriyama S, Hayashi H, Jingami Y, et al. Efficacy of inverted internal limiting membrane flap technique for the treatment of macular hole in high myopia[J]. Am J Ophthalmol, 2013, 156(1): 125-131. DOI: 10.1016/j.ajo.2013.02.014.
5.	Wakabayashi T, Ikuno Y, Shiraki N, et al. Inverted internal limiting membrane insertion versus standard internal limiting membrane peeling for macular hole retinal detachment in high myopia: one-year study[J]. Graefe's Arch Clin Exp Ophthalmol, 2018, 256(8): 1387-1393. DOI: 10.1007/s00417-018-4046-1.
6.	Ikuno Y, Sayanagi K, Soga K, et al. Foveal anatomical status and surgical results in vitrectomy for myopic foveoschisis[J]. Jpn J Ophthalmol, 2008, 52(4): 269-276. DOI: 10.1007/s10384-008-0544-8.
7.	Alkabes M, Mateo C. Macular buckle technique in myopic traction maculopathy: a 16-year review of the literature and a comparison with vitreous surgery[J]. Graefe's Arch Clin Exp Ophthalmol, 2018, 256(5): 863-877. DOI: 10.1007/s00417-018-3947-3.
8.	Liu B, Chen S, Li Y, et al. Comparison of macular buckling and vitrectomy for the treatment of macular schisis and associated macular detachment in high myopia: a randomized clinical trial[J/OL]. Acta Ophthalmol, 2020, 98(3): e266-e272[2019-11-17]. https://pubmed.ncbi.nlm.nih.gov/31736279/. DOI: 10.1111/aos.14260.
9.	Zhao X, Li Y, Ma W, et al. Macular buckling versus vitrectomy on macular hole associated macular detachment in eyes with high myopia: a randomised trial[J]. Br J Ophthalmol, 2022, 106(4): 582-586. DOI: 10.1136/bjophthalmol-2020-317800.
10.	Qi Y, Duan AL, You QS, et al. Posterior scleral reinforcement and vitrectomy for myopic foveoschisis in extreme myopia[J]. Retina, 2015, 35(2): 351-357. DOI: 10.1097/IAE.0000000000000313.
11.	Ando F, Ohba N, Touura K, et al. Anatomical and visual outcomes after episcleral macular buckling compared with those after pars plana vitrectomy for retinal detachment caused by macular hole in highly myopic eyes[J]. Retina, 2007, 27(1): 37-44. DOI: 10.1097/01.iae.0000256660.48993.9e.
12.	Ripandelli G, Coppé AM, Fedeli R, et al. Evaluation of primary surgical procedures for retinal detachment with macular hole in highly myopic eyes: a randomized comparison of vitrectomy versus posterior episcleral buckling surgery[J]. Ophthalmology, 2001, 108(12): 2258-2264. DOI: 10.1016/s0161-6420(01)00861-2.
13.	Ando F. Use of a special maculae explant in surgery for retinal detachment in macular hole[J]. Jpn J Ophthalmol, 1980, 24: 29-34.
14.	Devin F, Tsui I, Morin B, et al. T-shaped scleral buckle for macular detachments in high myopes[J]. Retina, 2011, 31(1): 177-180. DOI: 10.1097/IAE.0b013e3181fc7e73.
15.	Stirpe M, Ripandelli G, Rossi T, et al. A new adjustable macular buckle designed for highly myopic eyes[J]. Retina, 2012, 32(7): 1424-1427. DOI: 10.1097/IAE.0b013e3182550648.
16.	Parolini B, Frisina R, Pinackatt S, et al. A new L-shaped design of macular buckle to support a posterior staphyloma in high myopia[J]. Retina, 2013, 33(7): 1466-1470. DOI: 10.1097/IAE.0b013e31828e69ea.
17.	Zhao X, Ma W, Lian P, et al. Three-year outcomes of macular buckling for macular holes and foveoschisis in highly myopic eyes[J/OL]. Acta Ophthalmol, 2020, 98(4): e470-e478[2019-11-19]. https://pubmed.ncbi.nlm.nih.gov/31742899/. DOI: 10.1111/aos.14305.
18.	Theodossiadis GP, Theodossiadis PG. The macular buckling procedure in the treatment of retinal detachment in highly myopic eyes with macular hole and posterior staphyloma: mean follow-up of 15 years[J]. Retina, 2005, 25(3): 285-289. DOI: 10.1097/00006982-200504000-00006.
19.	Suda K, Hangai M, Yoshimura N. Axial length and outcomes of macular hole surgery assessed by spectral-domain optical coherence tomography[J]. Am J Ophthalmol, 2011, 151(1): 118-127. DOI: 10.1016/j.ajo.2010.07.007.
20.	Wu TT, Kung YH. Comparison of anatomical and visual outcomes of macular hole surgery in patients with high myopia vs. non-high myopia: a case-control study using optical coherence tomography[J]. Graefe's Arch Clin Exp Ophthalmol, 2012, 250(3): 327-331. DOI: 10.1007/s00417-011-1821-7.
21.	Nadal J, Verdaguer P, Canut MI. Treatment of retinal detachment secondary to macular hole in high myopia: vitrectomy with dissection of the inner limiting membrane to the edge of the staphyloma and long-term tamponade[J]. Retina, 2012, 32(8): 1525-1530. DOI: 10.1097/IAE.0b013e3182411cb8.
22.	Essex RW, Kingston ZS, Moreno-Betancur M, et al. The effect of postoperative face-down positioning and of long-versus short-acting gas in macular hole surgery: results of a registry-based study[J]. Ophthalmology, 2016, 123(5): 1129-1136. DOI: 10.1016/j.ophtha.2015.12.039.
23.	Ezra E, Gregor ZJ, Morfields Macular Hole Study Group. Surgery for idiopathic full-thickness macular hole: two-year results of a randomized clinical trial comparing naturalhistory, vitrectomy, and vitrectomy plus autologous serum: moorfields macularhole study group report no. 1[J]. Arch Ophthalmol Chic, 2004, 122(2): 224-236. DOI: 10.1001/archopht.122.2.224.
24.	Chen L, Wei Y, Zhou X, et al. Morphologic, biomechanical, and compositional features of the internal limiting membrane in pathologic myopic foveoschisis[J]. Invest Ophth Vis Sci, 2018, 59(13): 5569-5578. DOI: 10.1167/iovs.18-24676.
25.	Yokota R, Hirakata A, Hayashi N, et al. Ultrastructural analyses of internal limiting membrane excised from highly myopic eyes with myopic traction maculopathy[J]. Jpn J Ophthalmol, 2018, 62(1): 84-91. DOI: 10.1007/s10384-017-0542-9.
26.	Tornambe PE. Macular hole genesis: the hydration theory[J]. Retina, 2003, 23(3): 421-424. DOI: 10.1097/00006982-200306000-00028.
27.	Tang N, Zhao X, Chen J, et al. Changes in the choroidal thickness after macular buckling in highly myopic eyes[J]. Retina, 2021, 41(9): 1858-1866. DOI: 10.1097/IAE.0000000000003125.
28.	Grossniklaus HE, Green WR. Choroidal neovascularization[J]. Am J Ophthalmol, 2004, 137(3): 496-503. DOI: 10.1016/j.ajo.2003.09.042.

1. Ruiz-Medrano J, Montero JA, Flores-Moreno I, et al. Myopic maculopathy: current status and proposal for a new classification and grading system (ATN)[J]. Prog Retin Eye Res, 2019, 69: 80-115. DOI: 10.1016/j.preteyeres.2018.10.005.
2. Ohno-Matsui K, Wu PC, Yamashiro K, et al. IMI pathologic myopia[J/OL]. Invest Ophthalmol Vis Sci, 2021, 62(5): 5[2021-06-01]. https://pubmed.ncbi.nlm.nih.gov/33909033/. DOI: 10.1167/iovs.62.5.5.
3. Kadonosono K, Yazama F, Itoh N, et al. Treatment of retinal detachment resulting from myopic macular hole with internal limiting membrane removal[J]. Am J Ophthalmol, 2001, 131(2): 203-207. DOI: 10.1016/s0002-9394(00)00728-5.
4. Kuriyama S, Hayashi H, Jingami Y, et al. Efficacy of inverted internal limiting membrane flap technique for the treatment of macular hole in high myopia[J]. Am J Ophthalmol, 2013, 156(1): 125-131. DOI: 10.1016/j.ajo.2013.02.014.
5. Wakabayashi T, Ikuno Y, Shiraki N, et al. Inverted internal limiting membrane insertion versus standard internal limiting membrane peeling for macular hole retinal detachment in high myopia: one-year study[J]. Graefe's Arch Clin Exp Ophthalmol, 2018, 256(8): 1387-1393. DOI: 10.1007/s00417-018-4046-1.
6. Ikuno Y, Sayanagi K, Soga K, et al. Foveal anatomical status and surgical results in vitrectomy for myopic foveoschisis[J]. Jpn J Ophthalmol, 2008, 52(4): 269-276. DOI: 10.1007/s10384-008-0544-8.
7. Alkabes M, Mateo C. Macular buckle technique in myopic traction maculopathy: a 16-year review of the literature and a comparison with vitreous surgery[J]. Graefe's Arch Clin Exp Ophthalmol, 2018, 256(5): 863-877. DOI: 10.1007/s00417-018-3947-3.
8. Liu B, Chen S, Li Y, et al. Comparison of macular buckling and vitrectomy for the treatment of macular schisis and associated macular detachment in high myopia: a randomized clinical trial[J/OL]. Acta Ophthalmol, 2020, 98(3): e266-e272[2019-11-17]. https://pubmed.ncbi.nlm.nih.gov/31736279/. DOI: 10.1111/aos.14260.
9. Zhao X, Li Y, Ma W, et al. Macular buckling versus vitrectomy on macular hole associated macular detachment in eyes with high myopia: a randomised trial[J]. Br J Ophthalmol, 2022, 106(4): 582-586. DOI: 10.1136/bjophthalmol-2020-317800.
10. Qi Y, Duan AL, You QS, et al. Posterior scleral reinforcement and vitrectomy for myopic foveoschisis in extreme myopia[J]. Retina, 2015, 35(2): 351-357. DOI: 10.1097/IAE.0000000000000313.
11. Ando F, Ohba N, Touura K, et al. Anatomical and visual outcomes after episcleral macular buckling compared with those after pars plana vitrectomy for retinal detachment caused by macular hole in highly myopic eyes[J]. Retina, 2007, 27(1): 37-44. DOI: 10.1097/01.iae.0000256660.48993.9e.
12. Ripandelli G, Coppé AM, Fedeli R, et al. Evaluation of primary surgical procedures for retinal detachment with macular hole in highly myopic eyes: a randomized comparison of vitrectomy versus posterior episcleral buckling surgery[J]. Ophthalmology, 2001, 108(12): 2258-2264. DOI: 10.1016/s0161-6420(01)00861-2.
13. Ando F. Use of a special maculae explant in surgery for retinal detachment in macular hole[J]. Jpn J Ophthalmol, 1980, 24: 29-34.
14. Devin F, Tsui I, Morin B, et al. T-shaped scleral buckle for macular detachments in high myopes[J]. Retina, 2011, 31(1): 177-180. DOI: 10.1097/IAE.0b013e3181fc7e73.
15. Stirpe M, Ripandelli G, Rossi T, et al. A new adjustable macular buckle designed for highly myopic eyes[J]. Retina, 2012, 32(7): 1424-1427. DOI: 10.1097/IAE.0b013e3182550648.
16. Parolini B, Frisina R, Pinackatt S, et al. A new L-shaped design of macular buckle to support a posterior staphyloma in high myopia[J]. Retina, 2013, 33(7): 1466-1470. DOI: 10.1097/IAE.0b013e31828e69ea.
17. Zhao X, Ma W, Lian P, et al. Three-year outcomes of macular buckling for macular holes and foveoschisis in highly myopic eyes[J/OL]. Acta Ophthalmol, 2020, 98(4): e470-e478[2019-11-19]. https://pubmed.ncbi.nlm.nih.gov/31742899/. DOI: 10.1111/aos.14305.
18. Theodossiadis GP, Theodossiadis PG. The macular buckling procedure in the treatment of retinal detachment in highly myopic eyes with macular hole and posterior staphyloma: mean follow-up of 15 years[J]. Retina, 2005, 25(3): 285-289. DOI: 10.1097/00006982-200504000-00006.
19. Suda K, Hangai M, Yoshimura N. Axial length and outcomes of macular hole surgery assessed by spectral-domain optical coherence tomography[J]. Am J Ophthalmol, 2011, 151(1): 118-127. DOI: 10.1016/j.ajo.2010.07.007.
20. Wu TT, Kung YH. Comparison of anatomical and visual outcomes of macular hole surgery in patients with high myopia vs. non-high myopia: a case-control study using optical coherence tomography[J]. Graefe's Arch Clin Exp Ophthalmol, 2012, 250(3): 327-331. DOI: 10.1007/s00417-011-1821-7.
21. Nadal J, Verdaguer P, Canut MI. Treatment of retinal detachment secondary to macular hole in high myopia: vitrectomy with dissection of the inner limiting membrane to the edge of the staphyloma and long-term tamponade[J]. Retina, 2012, 32(8): 1525-1530. DOI: 10.1097/IAE.0b013e3182411cb8.
22. Essex RW, Kingston ZS, Moreno-Betancur M, et al. The effect of postoperative face-down positioning and of long-versus short-acting gas in macular hole surgery: results of a registry-based study[J]. Ophthalmology, 2016, 123(5): 1129-1136. DOI: 10.1016/j.ophtha.2015.12.039.
23. Ezra E, Gregor ZJ, Morfields Macular Hole Study Group. Surgery for idiopathic full-thickness macular hole: two-year results of a randomized clinical trial comparing naturalhistory, vitrectomy, and vitrectomy plus autologous serum: moorfields macularhole study group report no. 1[J]. Arch Ophthalmol Chic, 2004, 122(2): 224-236. DOI: 10.1001/archopht.122.2.224.
24. Chen L, Wei Y, Zhou X, et al. Morphologic, biomechanical, and compositional features of the internal limiting membrane in pathologic myopic foveoschisis[J]. Invest Ophth Vis Sci, 2018, 59(13): 5569-5578. DOI: 10.1167/iovs.18-24676.
25. Yokota R, Hirakata A, Hayashi N, et al. Ultrastructural analyses of internal limiting membrane excised from highly myopic eyes with myopic traction maculopathy[J]. Jpn J Ophthalmol, 2018, 62(1): 84-91. DOI: 10.1007/s10384-017-0542-9.
26. Tornambe PE. Macular hole genesis: the hydration theory[J]. Retina, 2003, 23(3): 421-424. DOI: 10.1097/00006982-200306000-00028.
27. Tang N, Zhao X, Chen J, et al. Changes in the choroidal thickness after macular buckling in highly myopic eyes[J]. Retina, 2021, 41(9): 1858-1866. DOI: 10.1097/IAE.0000000000003125.
28. Grossniklaus HE, Green WR. Choroidal neovascularization[J]. Am J Ophthalmol, 2004, 137(3): 496-503. DOI: 10.1016/j.ajo.2003.09.042.

Chinese Journal of Ocular Fundus Diseases

Four-year outcomes of macular buckling for traction maculopathy in highly myopic eyes

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content