Illuminated Ando Plombe for Optimal Positioning in Highly Myopic Eyes With Vitreoretinal Diseases Secondary to Posterior Staphyloma

Abstract

Retinal detachment secondary to a macular hole and retinoschisis are complications that can occur in highly myopic eyes. The posterior staphyloma plays an important role in the pathogenesis of these complications in conjunction with other factors such as anteroposterior traction caused by the vitreous cortex, tangential forces due to epiretinal membranes or the internal limiting membrane, and stretched retinal arteries. Varioussurgicalprocedureshavebeendescribedforthetreatment ofretinaldetachment inmyopicmacularholeandfoveoschisis, includingparsplanavitrectomywithintraoculartamponadeandwithorwithout internal limitingmembraneremoval,scleralshortening,andmacular buckling. Several recently published reports describe the success rate of episcleralmacular buckling in highlymyopic eyes.1-10 Different types of macular buckles have been proposed, but proper alignment of the buckle under the fovea is still a major concern in this technique. Siam et al7 reported the use of external posterior landmarks to allow better positioning of the indenting head, but this technique required superior oblique tendon rupture. Stirpe et al10 reported an adjustable macular buckle but indicated that the lateral rectus should be disinserted to ensure correct positioning of the indenting platform. To avoid any damage to extraocularmuscle and to enhance visualization, we propose the insertion of an optical fiber coupled to Video at jamaophthalmology.com