A Titanium Macular Buckle Implant Designed for an Easy Placement in Myopic Macular Holes

Abstract

Purpose: A new easy-to-place titanium macular buckle implant and the surgical technique for placing it in myopic macular holes are presented. A 60-year-old patient with pathologic myopia presented with macular holes in both eyes. The hole in the right eye was recurrent and long-standing since the initial diagnosis, which was over 5 years ago. He refused surgery for the better seeing left eye. The vision of the right eye was 20/200. The patient only wanted macular hole repair in the right eye if a macular buckle could be incorporated in the surgery.Methods: Because there was no commercially available macular buckle in the United States, a custom-made titanium buckle was designed and manufactured for this patient. In addition to the standard pars plana vitrectomy, internal limiting membrane peel, and gas tamponade, the titanium macular buckle was placed externally to provide indentation over the macula.Results: The titanium macular buckle provided approximately 1 mm of indentation, shortening the axial length from 28.88 mm to 27.94 mm. The macular hole was closed postoperatively. Postoperative best-corrected visual acuity was 20/200 at 1 month with no complications from the titanium macular buckle implant or the surgical technique. There was no improvement in the final visual acuity, which was attributed to foveal atrophy because of the long-standing nature of the macular hole.Conclusion: This titanium macular buckle implant designed for an easy placement could be an invaluable addition for surgical success in myopic macular pathologies, including myopic macular holes.

A New Model of a Macular Buckle and a Refined Surgical Technique for the Treatment of Myopic Traction Maculopathy

“…Macular buckle is an effective and safe procedure to treat maculoschisis and macular detachment in MTM. New interest in this surgical technique was demonstrated by different authors [ 15 , 16 ].…”

Management of Myopic Maculopathy: A Review

“…The Akduman Myopia Support device ( Figure 1 ) is a recently developed titanium macular buckle with several unique features that seem to make it advantageous. 42 Its concave supportive plate helps preserve the natural contour of the globe, possibly avoiding long-term foveal changes and any inhibition of the retina and choroidal circulation due to the indentation. 42 Furthermore, its fixed stiffness and size create a fixed final axial length regardless of initial axial length unless adjusted for pseudophakic eyes where a rather limited indentation is desired.…”

“… 42 Its concave supportive plate helps preserve the natural contour of the globe, possibly avoiding long-term foveal changes and any inhibition of the retina and choroidal circulation due to the indentation. 42 Furthermore, its fixed stiffness and size create a fixed final axial length regardless of initial axial length unless adjusted for pseudophakic eyes where a rather limited indentation is desired. A recent case report demonstrated successful resolution of maculoschisis with improvement in refraction by 7.25 D. 42 This patient, whose preoperative OCT, postoperative OCT, and postoperative fundus photos are seen in Figure 2 , had a reduction in axial length from 28.77 mm to 26.31 mm and also exhibited remarkable improvement in vision.…”

“… 42 Furthermore, its fixed stiffness and size create a fixed final axial length regardless of initial axial length unless adjusted for pseudophakic eyes where a rather limited indentation is desired. A recent case report demonstrated successful resolution of maculoschisis with improvement in refraction by 7.25 D. 42 This patient, whose preoperative OCT, postoperative OCT, and postoperative fundus photos are seen in Figure 2 , had a reduction in axial length from 28.77 mm to 26.31 mm and also exhibited remarkable improvement in vision. 43 The surgery of this case can be reviewed at: https://eyetube.net/videos/titanium-macular-buckle-placement.…”