The macular buckling technique in the treatment of optic disk pit maculopathy

In 1988 we introduced the macular buckling procedure for the treatment of optic disk pit maculopathy and we have been applying it since then. The surgery consists of a scleral sponge fixation of 7.5 x 5.5 mm at the posterior pole of the globe corresponding to the macula along the vertical axis of the 12 to 6 o'clock meridian. No additional treatment of any kind (laser, diathermy, or cryotherapy) is used. The correct positioning of the sponge during the surgery is monitored by B-scan ultrasonography. Within the first week after surgery, indocyanine green angiography (ICG) is used to evaluate the choroidal circulation. During the same period, magnetic resonance imaging (MRI) of the orbit is performed to determine the sponge position in relation to the optic nerve. We analyze the results of 23 eyes with optic disk pit maculopathy that underwent surgery with the macular buckling technique between November 1988 and December 1998. In 20 of them the macula and the surrounding area of the retina became completely flat. No recurrence was noted in the successfully treated patients in the follow-up period, which ranged from 9 months to 10 years. Visual acuity was improved by 1 to 7 Snellen lines in 18 of the 23 patients. An improvement in visual field indices was also recorded. The sponge positioning between the temporal part of the optic disk and the macula acts mechanically and seems to provide a barrier that prevents the flow of the fluid from the pit toward the macula.