Vitrectomy in high myopia: a narrative review

Abstract

Pathologic myopia is associated with degenerative changes of the globe, especially at the posterior pole. Eyes affected by pathologic myopia have higher odds to undergo posterior segment surgery and, in those eyes, vitreoretinal surgery is challenging. Many practical tips and tricks can make the surgical procedures simpler, significantly preventing sight-threatening intra- and post-operative complications. Moreover, novel surgical techniques and technological advancements (i.e. ad-hoc instrumentation, minimally invasive vitreoretinal surgery, filters, dye staining, intraoperative optical coherence tomography and 3-dimensional surgery) may play role in highly myopic eyes. The aim of the present work is to review practical tips and tricks, novel surgical techniques and technological advancements.Electronic supplementary materialThe online version of this article (doi:10.1186/s40942-017-0090-y) contains supplementary material, which is available to authorized users.

A human Amniotic Membrane plug to manage high myopic macular hole associated with retinal detachment

“…; Coppola et al. ). Various surgical methods have been carried out to achieve improvement of anatomic and functional outcomes for HMMH, including macular buckling (Sasoh et al.…”

“…High myopic macular holes (HMMH) associated with retinal detachment (RD) often causes severe visual impairment; it occurs mainly in older people with highly myopic eyes who have posterior staphyloma (Lim et al 2014;Coppola et al 2017). Various surgical methods have been carried out to achieve improvement of anatomic and functional outcomes for HMMH, including macular buckling (Sasoh et al 2000), pars plana vitrectomy (Ripandelli et al 2001;Ichibe et al 2003), vitrectomy with scleral imbrications (Matsuo et al 2001), vitrectomy with Internal limiting membrane (ILM) peeling staphyloma (Uemoto et al 2004;Oie et al 2007).…”

Macular optical coherence tomography findings after vitreoretinal surgery for rhegmatogenous retinal detachment

“…[1][2][3] Structural cross-sectional OCT has been gaining a pivotal role in the management of diverse retinal conditions, namely, diabetic macular edema, age-related macular degeneration, epiretinal membrane (ERM), macular hole (MH), and central serous retinopathy. 4,5 Despite the diagnosis of rhegmatogenous retinal detachment (RRD) being clinical or by ultrasonography (in opaque media), structural cross-sectional OCT can provide information before and after surgical repair with a relevant functional and prognostic value. 6,7 Both qualitative and quantitative OCT analysis of different parameters, that is, central macular thickness (CMT), outer retinal layer morphology, intraretinal fluid or subretinal fluid (SRF), in the macular region can help to predict visual outcome and may explain incomplete recovery after retinal reattachment.…”

<p>Treatment of recurrent myopic macular hole using membrane of plasma rich in growth factors</p>

“…The MH is a common finding in patients with high myopia, it is thought that its formation can be caused by the combination of tractional forces, at the macular level.1 The usual treatment for this pathology is PPV associated with procedures on ILM to decrease the tractional forces in the macula,1 such as the inverted ILM flap, the ILM peeling alone or with autologous PRPs (platelet-rich plasma) injection over the hole, autologous transplantation of ILM membrane, lens capsular flap, or neurosensory retina.10 In the inverted ILM flap technique, as well as in the autologous transplantation, the ILM acts as a scaffold for reactive gliosis and proliferation of glial cells, and therefore the anatomic closure of the MH is more easily produced.11 Likewise, the ILM could act as a barrier that prevents the penetration of fluids from the vitreous cavity to the macular orifice, preserving the function of the retinal pigment epithelium. However, the closure of the myopic MH is unpredictable, and a second surgery may be required.12…”