Advantages:

To reduce the disadvantages of standard vitreoretinal instruments (cannulas and ILM forceps) which arise during the use on eyes with long axial length.

Methods:

Two types of aspiration cannulas and one ILM forceps for surgery on eyes with long axial length were designed on schematic eye drawing and manufactured. Forty-four eyes with high-grade myopia (axial length 28-33.5 mm) were operated for retinal detachment and macular hole with the use of the instruments developed. Modified 23 gauge cannulas “Bayonette“ and “Myopic“ were used for PFCL-silicone oil or fluid-air exchange in 24 eyes. Modified forceps “Myopic“ were used for ILM peeling in 20 eyes. Surgeries were performed under visual control using different viewing systems (EIBOS, OFFISS, BIOM, Resight).

Effectiveness / Safety:

In all cases bending of the newly developed instruments has extended the distance between the surgeon‘s fingers holding cannulas/forceps and viewing system lenses. Hence the frequency of lens touch and consequent visual field displacement was significantly less. Additionally, the curvature of “Myopic“ cannula and forceps has increased the amplitude of the instruments‘ tip movements on the retinal surfaces. Elongation of the working parts to 35 mm and the bending of the proposed vitreoretinal instruments allowed us to place cannulas and forceps under a steeper angle to the visual axis of the eye than usual and to reach the posterior pole of the retina without any difficulties. Conclusion: Usage of proposed vitreoretinal instruments (cannulas and forceps) seems to prevail over the use of straight ones making the maneuvering on the posterior retina in eyes with long axial length easier and avoiding contact with viewing system lenses. The use of the proposed instruments incurs additional cost and some short-term practice.

Take home message:

Widening of the range of vitreoretinal instruments can facilitate a personalized approach in the surgery of highly myopic eyes.