16.5.1 Myopic Traction Maculopathy – Macular Buckling

The previously described technique[18] for MB has been modified by Mura et al:[19]

• After 360° conjunctival peritomy, the 4 recti muscles and the inferior oblique muscle are isolated with 3-0 silk suture in the standard fashion for scleral buckling procedures
• The sub-Tenon’s space is exposed, and the sclera is inspected for thinning and to locate relevant vortex veins. The vortex veins, although variable in location and quantity, are typically located in the mid-quadrant between the recti muscles. They are carefully bluntly dissected away from the globe with dressing forceps and a Q-tip
• A 2-mm solid silicone band (FCI, Paris, France) is first passed under the lateral rectus muscle, then posteriorly under the inferior oblique muscle and finally beneath the inferotemporal inferior vortex vein.
• The band is fixed to the sclera along the nasal aspect of the inferior rectus insertion using 5-0 Mersilene suture (Ethicon Inc,Somerville, NJ)
• The solid silicone macular plate (FCI, Paris, France) is threaded on the free extremity of the 2-mm band in the superotemporal quadrant
• To avoid vortex vein compression, the other end of the 2-mm band is passed posterior to the superotemporal vortex vein, which is then positioned to the nasal aspect of the superior rectus muscle insertion
• A chandelier light with wide-angle viewing system is used to check the posterior indentation of the macular plate, the height of the buckle and to ensure that the nasal edge of the macular plate is adjacent to but not touching the optic nerve
• The height of the macular buckle is adjusted by lengthening or shortening the 2-mm band (by stretching or relaxing the 2-mm band positioned next to the superior rectus)
• The optic nerve and retina are carefully examined to ensure perfusion
• When the position of the macular plate is as desired to reoppose the posterior retina, the superior end of the 2-mm band is trimmed and sutured to the nasal aspect of the superior rectus tendon and the anterior end of the macular plate is trimmed and sutured underneath the lateral rectus muscle
• To close, Tenon’s and conjunctiva are pulled over the globe and the conjunctiva is sutured This procedure can be combined at the discretion of the surgeon and depending on the clinical aspects with vitrectomy, subretinal fluid drainage, and endotamponade (gas or silicone oil). (Figure 16.5.1 to Figure 16.5.4) show different views of the T-shaped macular buckle and its position on the eye.