Modified Curved Aspiration Cannulas and End-Gripping Forceps for 25-Gauge Vitrectomy on Highly Myopic Eyes

Macular Hole in Myopic Eyes: A Narrative Review of the Current Surgical Techniques

“…Considering that eyes with extremely high myopia can frequently exceed 30 mm in the axial length, surgical instrumentation, such as vitreous forceps, must be evaluated accurately during PPV. To overcome the inability to reach the retinal surface, surgeons can verticalize the instruments and carefully apply a pressure on the sclera wall in order to temporarily reduce the axial length of the globe [ 105 ]. However, these maneuvers are not free from complications, such as limited visibility due to erroneous contact and dislocation of the viewing system, corneal folds and impaired surgeon maneuverability which result in a longer operation time and challenging surgical procedures [ 106 ].…”

Vitrectomy in high myopia: a narrative review

“…fluid or perfluorocarbon liquid removal, ERM and inner limiting membrane [ILM] peeling) may be severely impaired [ 5 ]. The surgeon has to verticalize the instruments and apply pressure on the sclera in order to transitorily shorten the axial length of the eyeball [ 4 , 6 ]. All these elements result in reduced surgeon’s maneuverability, erroneous contact with the viewing system, limited visibility because of corneal folds, longer and more challenging surgical procedures [ 4 , 6 ].…”

“…The surgeon has to verticalize the instruments and apply pressure on the sclera in order to transitorily shorten the axial length of the eyeball [ 4 , 6 ]. All these elements result in reduced surgeon’s maneuverability, erroneous contact with the viewing system, limited visibility because of corneal folds, longer and more challenging surgical procedures [ 4 , 6 ]. Some practical tips can be employed to overcome these issues.…”

“…First, patients with high myopia should undergo axial length measurement and B-scan ultrasonography to identify eventual posterior staphyloma, to adequately plan the intraoperative approach [ 5 ]. In order to avoid instruments verticalization and to restore an adequate working angle, the distance between sclerotomies should be increased [ 6 ]. Contrary to 25- and 27-gauge (G) devices, 20-G instruments are longer enough to reach the posterior pole, and temporal sclerotomy can be enlarged in order to accommodate such instruments [ 5 ].…”

“…Recently, dedicated instrumentation has been developed to deal with longer eyes, such as long-shaft forceps and long cannulae, chosen on the basis of axial length [ 7 ]. In order to avoid conflict with the viewing system, curved elongated instruments can be used instead of straight elongated ones [ 6 ].…”