Ocular Motility Changes After Macular Buckle for Myopic Traction Maculopathy

PURPOSE: To evaluate ocular motility changes after NPB macular buckling surgery (AJL Ophthalmic). Myopic traction maculopathy is a sight-threatening complication of pathologic myopia. Macular buckling surgery, particularly with the novel NPB model, has shown high anatomical success, but concerns remain regarding possible orthoptic complications. METHODS: Consecutive patients with myopic traction maculopathy who underwent NPB macular buckling surgery at Eyecare Clinic, Brescia, Italy (January 2023 to July 2024) were retrospectively analyzed. Exclusion criteria included preexisting ocular motility disorders and monocular status. Preoperative and postoperative examinations included best corrected visual acuity, axial length, orthoptic evaluation (cover tests, ocular motility, binocular vision, and stereopsis), and diplopia assessment. The minimum follow-up was 6 months. RESULTS: Forty-two patients were enrolled; 12 (29%) were excluded because they showed preoperative ocular motility alterations. The remaining 30 patients achieved complete anatomical resolution of myopic traction maculopathy after surgery. Postoperatively, 13 patients (43%) developed elevation deficits, 10 (33%) hypotropia, and 9 (30%) diplopia in primary gaze. Diplopia was managed with prismatic correction, using glasses or soft prismatic contact lenses, in 7 patients, whereas 2 declined treatment. No patient required buckle removal. CONCLUSIONS: NPB macular buckling surgery effectively resolved myopic traction maculopathy in all cases, but induced mild ocular motility abnormalities in a subset of patients. These complications-mainly elevation deficit, hypotropia, and diplopia-were manageable with prismatic correction and appear acceptable when weighed against the anatomical and visual benefits.