Macular buckling for myopic macular hole retinal detachment: a new approach.

PURPOSE: To evaluate the efficacy and safety of a new technique of macular buckling in the treatment of myopic macular hole retinal detachment. METHODS: Twenty-six consecutive cases of myopic macular hole retinal detachment were included in the study. For 20 cases, the macular buckling was the primary procedure. The other six cases were recurrent after vitrectomy and silicone oil tamponade. The technique is described in detail. RESULTS: Retinal attachment occurred in all cases with improvement of vision. The postoperative vision ranged from counting fingers to 6/36 depending on the degree of atrophy of the retinal pigment epithelium in the background. Only one case developed submacular hemorrhage with deterioration of vision to counting fingers close to the eye. Other complications were recorded. CONCLUSION: The described technique is remarkably accurate and does not require any specially designed implants. It is highly recommended for cases of myopic macular hole retinal detachment with atrophic background and deep posterior staphyloma and for recurrent cases after vitrectomy with or without silicone oil.

A restudy of the surgical anatomy of the posterior aspect of the globe: an essential topography for exact macular buckling.

PURPOSE: To study the anatomy of the posterior aspect of the globe comparing it with previous textbook descriptions, to find constant anatomical landmarks for macular buckling surgery. DESIGN: This is an anatomical study on cadaver eyes with additional in vivo measurements during the macular buckling procedure. METHODS: Twelve cadaver eyes were carefully dissected identifying important structures on the posterior aspect of the globe and measuring their cross-diameters and relative distances. The distance of the medial end of inferior oblique insertion from the foveal position projected on the scleral surface and the border of the optic nerve sheath were measured. The intrascleral course of temporal long posterior ciliary artery was identified and measured, and its distance from the optic nerve sheath was also measured. RESULTS: The macula consistently lies on the horizontal meridian (foveal horizontal meridian) defined by the course of the long posterior ciliary arteries, which cross the optic nerve somewhere between its center and its lower border. CONCLUSION: The horizontal meridian (foveal horizontal meridian), defined by the entry site and course of the long posterior ciliary arteries, serves as an important surgical landmark if precise external scleral buckling of the fovea is the objective. For practical purposes, foveal horizontal meridian, geometrical horizontal meridian, and optic nerve horizontal meridian need to be distinguished.