Retinal detachment in high myopia is due to a combination of anteroposterior traction (due to the elongation of the sclera unmatched to the elongation of the retina) and of tangential tractions (due to the formation of epiretinal contraction. I will discuss why it is not possible to propose vitrectomy as the only choice, since vitrectomy is related to a high rate of retinal detachment relapse and since, in case of an associated macular hole, the hole remains open. Anteroposterior traction can be counteracted only by a posterior pushing action by a scleral macular buckle. Vitrectomy may be associated to remove the epiretinal proliferation.

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Barbara Parolini