Abstract General Information

Título/Title

MACULAR BUCKLE COMBINED WITH PARS PLANA VITRECTOMY, INNER LIMITING MEMBRANE PEEL AND INVERTED FLAP AND GAS ENDOTAMPONADE FOR MACULAR DETACHMENT SECONDARY TO FULL THICKNESS MACULAR HOLE IN MYOPIC STAPHYLOMA

Resumo/Abstracts

Purpose: To report a case of macular detachment with macular hole (MHMD) in myopic staphyloma (MS) treated with macular buckle (MB) combined with pars plana vitrectomy (PPV).

Methods: A 64-yrs-old pseudophakic patient presented for right MHMD secondary to full-thickness-macular-hole (FTMH) 720-mm in diameter with MS. His pre-operative best corrected visual acuity (BCVA) and axial lenght measured counting fingers and 27.69 mm. MB combined with PPV, inner limiting membrane (ILM) peel, ILM inverted flap and C2F6 endotamponade were performed, a combined intraocular approach being chosen in addition to MB given the FTMH associated with MHMD in high-myopic eye.

A newly designed MB with four holes and wider arm was sutured at the superotemporal sclera, the distance limbus-needle at which both anterior holes were sutured measuring 9-mm and 8-mm for the temporal and superior hole of the MB respectively.

Results: 25G PPV, ILM peeling up to vascular arcades and an ILM inverted flap over the FTMH were performed. MB position was verified during PPV, followed by slow fluid-air exchange and C2F6 18% gas endotamponade. 3 months post-operatively, BCVA and axial lenght measured 20/200 and 27.58 mm, examination and macular OCT revealed posterior pole reattachment with sealed FTMH, high MB indent and reconstitution of outer retinal layers.

Conclusions: ab-externo MB without PPV for MHMD in MS has been reported, however MB combined with PPV, ILM peel/inverted flap and gas endotamponade has been reported once with various post-operative complications. The newly designed MB with four holes and wider arm reduces risk of intraoperative slippage.