MACULARBUCKLEFORRETINALDETACHMENTWITHMACULARHOLE– CASEREPORT

17th EVRSMEETING

LuísaMalheiro1,BernardetePessoa1,JoãoMeloBeirão1,AngelinaMeireles1

1 Ophthalmological Department - CentroHospitalarUniversitáriodoPorto,Portugal

MACULARBUCKLEFORRETINALDETACHMENTWITHMACULARHOLE– CASEREPORT

INTRODUCTION: Macular buckling is a surgical technique used for retinal detachments dueto macular hole in high myopic patients. The purpose of the macular buckle is to counteractthe pulling effect of the posterior staphyloma.

MACULARBUCKLEFORRETINALDETACHMENTWITHMACULARHOLE– CASEREPORT

CLINICALHISTORY:

- 65years-old female patient.

- High myopic.

- Loss of visualacuity inthe right eyewith twomonths of evolution.

- Nohistory of traumaor previousophthalmological surgeries.

OPHTHALMOLOGICALEVALUATION:

- BCVA:ORhandmovements,OS 20/200with spectacles

- Biomicroscopy:bilateralcataracts,depth anteriorchamber

- IOP:14/30mmHg

- Fundoscopy:bilateralmyopic coroidosis,posteriorpolestaphyloma,retinal detachment associated with amacularhole inthe OR

- Axiallength:OR 30,86mm,OS 30,72mm

MACULARBUCKLEFORRETINALDETACHMENTWITHMACULARHOLE– CASEREPORT

ThepatientwassubmittedtoacombinedPHACOVITRECTOMY intherighteye:

Epirretinal peeling +invertedinternallimitingmembraneflaptechniqueformacularhole+peripheralretinotomy toremovethesubretinal fluid+periretinotomy endolaser +Octafluoropropane (C3F8)forendotamponade

MACULARBUCKLEFORRETINALDETACHMENTWITHMACULARHOLE– CASEREPORT

2 monthspostoperatively

Two months after,macularhole wasclosed but subretinal fluid was stillpresent at the posteriorstaphyloma.

ThepatientwasthensubmittedtoMACULARBUCKLINGSURGERY: AJLmacularbuckle (AJLOphthalmicSpain)

3 monthspostoperatively

Postoperatively it was registered anindentation of the superiormaculabut SD-OCTshowed that inferior

subfoveal fluid persisted.

MACULARBUCKLEFORRETINALDETACHMENTWITHMACULARHOLE– CASEREPORT

1 monthpostoperatively

The macularbuckle was readjusted andmoreinferiorly displaced.

7months after

Onemonth after reintervention,SD-OCTrevealed macularindentation

with nosubretinal fluid orretinoschisis.

MACULARBUCKLEFORRETINALDETACHMENTWITHMACULARHOLE– CASEREPORT

ONTHELASTOPHTHALMOLOGICALAPPOINTMENT:

8 months after

BCVA: OR 20/400Biomicroscopy: pseudophakic, no anteriorchamber reaction

IOP:16mmHg with timolol +brinzolamide +brimonidine

SD-OCT:nosubretinal fluid

Fundoscopy:myopiccoroidosis, closed macularhole,attached retina

MACULARBUCKLEFORRETINALDETACHMENTWITHMACULARHOLE– CASEREPORT

CONCLUSION: Combined vitrectomy with macular buckling is an effective approach in thetreatment of retinal detachments due to macular hole in high myopic patients, improving bothvisual and anatomicoutcomes.

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