Myopic macular holes

Myopic traction maculopathy is common in highly myopic patients and characterized by different stages: macular schisis (MS),macular detachment (MD) without macular hole (MH), and MD with MH. MH-related retinal detachment is an uncommon complication associated with posterior staphyloma. Surgical management is based on transvitreal approach and posterior scleral procedure. Since the introduction of pars plana vitrectomy (PPV),retinal detachments with MH in highly myopic eyes were mostly treated with the transvitreal surgery. However,vitrectomy alone does not address the major risk factor of the macular schisis, which is the posterior staphyloma. To give a new shape and support to the posterior scleral wall by means of macular buckling has the advantage of releasing both the traction caused by the posterior staphyloma and the anteroposterior traction caused by the vitreous cortex. A more recent T-shaped scleral buckle has been proposed by Devin et al.

We performed this macular buckling combined or not with PPV as a primary surgery or with a previous failed surgical approach in patients affected by MH with MD and MH with or without MS.

In our opinion a combined surgical approach could be the most effective way to treat this disease.