Macular Buckling for Myopic Traction Maculopathy: A Comprehensive Systematic Review and Meta-Analysis

Purpose

Myopic traction maculopathy (MTM) is a major cause of visual impairment and blindness, particularly in Asian populations. With the global burden of myopia on the rise, understanding effective treatment options is crucial. This systematic review and meta-analysis evaluate the efficacy of macular buckling in the management of MTM.

Design

A systematic review and meta-analysis.

Methods

A systematic review and meta-analysis were conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed, Cochrane Library, and EMBASE databases were searched for relevant studies up to July 2024. Inclusion criteria encompassed studies reporting outcomes of macular buckling for MTM. Primary outcomes included changes in best-corrected visual acuity and axial length, retinal reattachment rate, and macular hole closure rate. Random-effect models were used for statistical analysis, with heterogeneity assessed using the I² statistic. The pooled results were reported as mean difference or proportion with corresponding 95% confidence intervals (CIs) for each outcome.

Results

Thirteen studies (482 eyes) met the inclusion criteria. Significant improvements in best-corrected visual acuity were observed across all follow-up periods, with the most substantial improvement in long-term outcomes (mean difference: 0.38 logarithm of the minimum angle of resolution; 95% CI: 0.28-0.47). Axial length showed consistent reductions, with a mean long-term reduction of 2.88 mm (95% CI: 2.54-3.21). The pooled long-term retinal reattachment rate was 94% (95% CI: 86%-97%), while the long-term full thickness macular hole closure rate was 72% (95% CI: 55%-85%). Heterogeneity varied across outcomes and follow-up periods, ranging from low to high.

Conclusions

Macular buckling demonstrates promising outcomes for MTM, including improved visual acuity, reduced axial length, high retinal reattachment rates, and favorable macular hole closure rates. These findings support the efficacy of macular buckling as a treatment option for MTM. However, further standardized, long-term studies are needed to confirm these results and explore potential combination therapies.