Abstract
Purpose: :
Macular buckles have been used to treat conditions such as myopic macular detachment by creating scleral indentation under macula. This study evaluates a macular buckle design to eliminate risk of scleral perforation from posterior placement of sutures, and provide improved control of amount and area of indentation. A relatively rigid buckling material, shaped to provide specific amount and area of indentation is proposed. When the convex contour of a more rigid buckling material is adhered to the sclera with adhesive, the scleral shape is forced to conform to the more rigid buckling element, thus creates effective indentation.
Methods: :
Fresh bovine globes were softened with paracentesis. Discs of cartilage of 3, 5, 7 and 9mm diameter was shaped with a blade. A convex contour of approximately 1.5 cm radius of curvature was fashioned on one side. Using cyanoacrylate tissue adhesive, the convex surface of the discs were adhere to posterior sclera with globe indentation. After proper fixation, infusion port was placed into the eye to test the tolerability of a glued macular buckle to physiologic pressures. B scan ultrasound was then performed to confirm indentation of the eye with adhesive macular buckle.
Results: :
Posterior scleral indentation was achieved when entire convex surface was attached with cyanoacrylate. Given similar radius of curvature, attachment and indentation with larger size buckle appear more effective. Macular buckle stayed adherent with proper indentation beyond intraocular pressure of 40mm Hg. External inspection and B-scan confirm effective indentation achieved with adhesive buckling.
Conclusions: :
Adhesive macular buckle provides effective posterior scleral indentation at physiologic intraocular pressures. Given a more appropriate buckle design, material and adhesive combination, an effectivly controlled sutureless indentation to macula, using this concept may be developed for future clinical use.
Keywords: vitreoretinal surgery • retinal detachment • myopia