Macular Buckling Surgery Using a Novel L-shaped Buckle for Patients with Myopic Tractional Maculopathy

Purpose: To describe the clinical characteristics and surgical outcomes of patients with myopic tractional maculopathy (MTM) who underwent macular buckling (MB) surgery using a novel L-shaped buckle.Methods: A titanium stent, a style 507 sponge, and a silicone sleeve were used to create an L-shaped macular buckle. The titanium stent was bent through 90° over the last third. The sponge was cut to about 1 cm in length and placed on the extremity. The remaining part of the stent was then covered with a 2-cm-long silicone sleeve; the total buckle length was 3 cm. The buckle was implanted supero-temporally to allow access to the macular region. Intraoperative optical coherence tomography (Zeiss Rescan 700, Carl Zeiss, Jena, Germany) was performed to ensure that the buckle was appropriately positioned.Results: Three patients with MTM underwent MB surgery under general anesthesia. In all patients, the foveae lay at the greatest distances possible from the posterior staphyloma. Given the location of the posterior staphyloma and the posterior scleral expansion, anteroposterior traction was evident in every patient. After surgery, although the extent varied, all patients exhibited reduced anteroposterior traction, evidenced by decreased retinoschisis, staphyloma flattening, and smaller macular holes. In one case, vitrectomy was added to release epiretinal membrane-induced tangential traction. No patient reported any significant ocular complication after surgery.Conclusions: MB using an L-shaped buckle, safely and efficiently relieves anteroposterior traction and improves the macular anatomy in patients with MTM.