Posterior Scleral Indentation in long axial length eyes (axial length more than 34 mm) to assist in pars plana vitrectomy and internal limiting membrane peeling in full thickness macular holes.

Abstract

To assess a novel surgical technique to perform macular surgery in high myopia eyes, with axial lengths more than 34 mm, where standard sized intravitreal surgical instruments cannot reach the retinal surface during pars plana vitrectomy for internal limiting membrane (ILM) peeling in myopic macular holes. Five eyes with axial length more than 34 mm were included in this study. A 7-mm Helvoston retractor was placed under tenon's capsule and guided along the eyeball until an elevation was noticed on the macular area. This elevation shortened the operating distance, temporarily, between the sclerotomy and retinal surface, enabling the use of standard size intraocular instruments. Preoperative vision and optical coherence tomography were compared with postoperative data and used as markers of anatomical and functional success. Vision improvement and anatomical closure of the macular hole with reattachment of the retina was achieved in all five eyes. No surgical complications associated with this surgical technique were noticed. Indenting the macular area from behind the eye globe with a 7-mm Helvoston retractor in a high myopic eye with axial length more than 34 mm during pars plana vitrectomy is safe and makes surgical procedures, such as ILM removal, easier.