Myopic foveoschisis (MF) affects 8–34% of eyes with high myopia[1,2] and is characterized by intraretinal splitting in the macular region, representing a major cause of visual loss in highly myopic eyes. The term myopic foveal retinoschisis was initially described in 1958 by Calbert Phillips, who proposed that localized posterior retinal macular detachment (MD) over the posterior staphyloma may occur without a detectable macular hole (MH).[3,4]
The management of MF has inspired much debate. Elimination of epiretinal traction by means of vitrectomy with or without internal limiting membrane (ILM) peeling seems a reasonable approach and has proven to be effective in MF[5,6] despite not exempt from complications such as MH formation, extrafoveal retinal hole formation or physiologic changes in the macular area. Moreover, some reports suggest that vitrectomy, with or without ILM peeling, only causes a transient release of the traction without addressing the major risk factor associated with the development of the MF, which is the posterior staphyloma.
Reshaping and providing support to the posterior scleral wall by means of macular buckling (MB) has the advantage of releasing both the anteroposterior traction caused by the posterior staphyloma and the tangential traction caused by the vitreous cortex.[11,12,13]
Several buckles designs and techniques have been developed to treat these myopic sequelae.[14,15,16,17,18]
Our preferred approach is outlined below:
Wu PC, Chen YJ, Chen YH, et al. Factors associated with foveoschisis and foveal detachment without macular hole in high myopia. Eye. 2009. doi:10.1038/sj.eye.6703038
Baba T, Ohno-Matsui K, Futagami S, et al. Prevalence and characteristics of foveal retinal detachment without macular hole in high myopia. Am J Ophthalmol. 2003;135(3):338-342. doi:10.1016/S0002-9394(02)01937-2
Kanda S, Uemura A, Sakamoto Y, Kita H. Vitrectomy with internal limiting membrane peeling for macular retinoschisis and retinal detachment without macular hole in highly myopic eyes. Am J Ophthalmol. 2003. doi:10.1016/S0002-9394(03)00243-5
Ikuno Y, Sayanagi K, Ohji M, et al. Vitrectomy and internal limiting membrane peeling for myopic foveoschisis. Am J Ophthalmol. 2004. doi:10.1016/j.ajo.2003.10.019
Wolf S, Schnurbusch U, Wiedemann P, Grosche J, Reichenbach A, Wolburg H. Peeling of the basal membrane in the human retina: Ultrastructural effects. Ophthalmology. 2004. doi:10.1016/j.ophtha.2003.05.022
Theodossiadis GP, Theodossiadis PG. The macular buckling procedure in the treatment of retinal detachment in highly myopic eyes with macular hole and posterior staphyloma: Mean follow-up of 15 years. Retina. 2005;25(3):285-289. doi:10.1097/00006982-200504000-00006
Sasoh M, Yoshida S, Ito Y, Matsui K, Osawa S, Uji Y. Macular buckling for retinal detachment due to macular hole in highly myopic eyes with posterior staphyloma. Retina. 2000;20(5):445-9. doi: 10.1097/00006982-200009000-00003.
Stirpe M, Ripandelli G, Rossi T, Cacciamani A, Orciuolo M. A New Adjustable Macular Buckle Designed for. Retina. 2012;32(7):1424-1427.
Ando F, Ohba N, Touura K, Hirose H. Anatomical and visual outcomes after episcleral macular buckling compared with those after pars plana vitrectomy for retinal detachment caused by macular hole in highly myopic eyes. Retina. 2007. doi:10.1097/01.iae.0000256660.48993.9e
Mateo C, Medeiros MD, Alkabes M, Burés-Jelstrup A, Postorino M, Corcóstegui B. Illuminated ando plombe for optimal positioning in highly myopic eyes with vitreoretinal diseases secondary to posterior staphyloma. JAMA Ophthalmol. 2013;131(10):1359-1362. doi:10.1001/jamaophthalmol.2013.4558
Mateo C, Burés-Jelstrup A, Navarro R, Corcóstegui B. Macular buckling for eyes with myopic foveoschisis secondary to posterior staphyloma. Retina. 2012;32(6):1121-1128. doi:10.1097/IAE.0b013e31822e5c32
Parolini B, Frisina R, Pinackatt S, Mete M. A New L-shaped design of macular buckle to support a posterior staphyloma in high myopia. Retina. 2013;33(7):1466-1470. doi:10.1097/IAE.0b013e31828e69ea
Devin F, Tsui I, Morin B, Duprat JP, Hubschman JP. T-shaped scleral buckle for macular detachments in high myopes. Retina. 2011;31(1):177-180. doi:10.1097/IAE.0b013e3181fc7e73
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