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.
Various surgical procedures have been described for the treatment of retinal detachment in myopic macular hole and foveoschisis, including pars plana vitrectomy with intraocular tamponade and with or without internal limiting membrane removal, scleral shortening, and macular buckling. Several recently published reports describe the success rate of episcleral macular buckling in highly myopic eyes.1- 10
A, Partially bent Ando plombe. B, The 29-gauge optic fiber is inserted through the needle shaft. C, With the optic fiber partially retracted, the distal silicone plate of the Ando plombe is perforated with the needle to the center of the indenting heel. D, The optic fiber is pushed into the silicone terminal platform. E, The needle is then removed from the Ando plombe. F, The optic fiber is sutured and secured to the Ando plombe with 2 nylon sutures to avoid accidental removal.
Asterisk indicates the shaft of the Ando plombe running to the temporal and anterior part of the eye; arrows, the illuminated distal plate of the Ando plombe; and arrowhead, fovea.
A, Optical coherence tomography shows retinal detachment related to a macular hole in the area of the staphyloma. B, After surgery, the retina is reattached once the gas has disappeared. C, Optical coherence tomography shows a progressive retinoschisis with an inner macular hole. D, Three weeks after surgery, foveal contour is clearly seen in the center of the buckled area. I indicates inferior; N, nasal; S, superior; and T, temporal.
A, Optical coherence tomography shows a full-thickness macular hole with retinoschisis. B, Three weeks after surgery, the macular hole is closed and the retinoschisis has improved. C, Macular retinoschisis with foveal detachment. D, Four weeks after surgical treatment, the foveal thickness has become normal and the schisis has progressively decreased. I indicates inferior; N, nasal; S, superior; and T, temporal.
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Placement of Ando Plombe
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