Modification of Silicone Materials in T-Shaped Macular Buckling Surgery

Purpose: To describe a novel approach for macular buckling surgery in myopic traction maculopathy and report its outcomes after 12 months. Methods: This retrospective study included patients with myopic traction maculopathy who had no significant tractional membranes and underwent macular buckling surgery, with or without vitrectomy, for macular detachment, macular hole (MH), or MH-associated retinal detachment (RD). The silicone materials commonly used during RD surgeries were modified into a T shape, allowing for the indentation of the posterior pole through a vertical approach and avoiding the need to forcefully advance the material into the deep temporal sclera. Results: Of the 22 patients (mean age, 67.2 years; best-corrected visual acuity [BCVA], 20/400 to hand motions), 15 with macular detachment underwent macular buckling surgery alone; their mean ± SD logMAR BCVA improved to 0.82 ± 0.40 [Snellen 20/125^-1] and 0.67 ± 0.42 [20/100⁺¹] at 6 and 12 months, respectively. The median duration for foveal reattachment was 3.5 months. One patient underwent macular buckling surgery alone for myopic MH with an adherent operculum, and 2 patients with MH-associated early-stage RD underwent macular buckling surgery followed by pure sulfur hexafluoride injection. The remaining patients underwent macular buckling surgery combined with vitrectomy, fluid-gas exchange, and internal limiting membrane inversion for MH with total RD. At 12 months, the mean axial length decreased from 29.9 ± 2.4 mm preoperatively to 28.4 ± 2.78 mm. All patients achieved retinal reattachment without developing macular atrophy. Conclusions: Our technique used standard silicone materials to construct the buckles used intraoperatively and showed favorable anatomic outcomes, suggesting it as another option for myopic traction maculopathy with macular detachment.