Real-World Outcomes of Macular Buckling Surgery for Myopic Traction Maculopathy: A Decade of Clinical Experience
DOI:
https://doi.org/10.48560/rspo.33255Keywords:
Macular Degeneration, Myopia, Degenerative, Retinal Detachment, Visual AcuityAbstract
INTRODUCTION: Myopic traction maculopathy (MTM) often presents as a therapeutic challenge. While pars plana vitrectomy (PPV) remains the mainstay treatment, macular buckling (MB) offers a promising alternative designed to counter the tractional force of the staphyloma. This study aims to evaluate the functional and structural outcomes of MB in treating MTM.METHODS: A retrospective review was conducted on patients who underwent MB surgery between 2012 and 2023. Outcomes analyzed include anatomical success rates, best-corrected visual acuity (BCVA) expressed in decimal notation, axial length (AL), and surgical complications.
RESULTS: Of the 200 clinical files analyzed, 75% were female patients and 52% right eyes. According to the MTM staging system, retinal stages were stage 1 in 9.5%, stage 2 in 29%, stage 3 in 32%, and stage 4 in 24.5% of eyes. For the foveal stages, 44.5% of eyes were in stage a, 33% in stage b, and 22.5% in stage c, with 43.5% presenting epiretinal changes. Sixty nine percent underwent MB alone, while 31% had a combined procedure with PPV. There was a significant BCVA improvement of 0.21 diopters from preoperative to 1-year postoperative (n=64, p=0.001). When comparing the 1-year postoperative BCVA to the last appointment (n=56), the difference was only -0.01, with a mean follow-up of 41 months (p=0.593). BCVA improved in 76.6% of eyes, remained stable in 13.6%, and decreased in 9.7%. Anatomical assessments revealed the following for the fovea: 80.9% resolution, 9.9% improvement, and 8.0% no change and 1.2% deterioration. For the retina, there was 89.5% resolution, 9.3% improvement and 1.8% no change. The AL decreased from 31.18 mm preoperative to 29.78 mm postoperative (p <0.001). Postoperatively, 9.5% of eyes required surgery revision and 10% of the eyes required a further PPV. MB was removed in 7.4% (n=14) of patients. Atrophy progression was seen in 41.3% of operated eyes and in 51.1% of the fellow eyes. Regarding retinal stage 3 and 4 (n=122), macular reattachment was achieved in 100%. Macular hole closure was achieved in 92.9% of the cases with one intervention.
CONCLUSION: MB stands out as an effective and safe technique for MTM treatment in highly myopic eyes.
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