Pathologic myopia is characterized by excessive axial elongation with progressive degeneration of the posterior pole. It is often associated with posterior staphyloma or patchy chorioretinal atrophy at the posterior pole. In addition, it may lead to various complications requiring surgical management including myopic traction maculopathy and macular hole with or without retinal detachment. Recently, the introduction of surgical instrumentation in vitrectomy has facilitated the use of small gauge vitrectomy for complex cases with pathologic myopia. However, retinal surgeons, especially beginners, may meet obstacles during vitrectomy in cases with pathologic myopia. This report represents several surgical tips for small gauge vitrectomy in pathologic myopia-related complications for novice retinal surgeons.

Methods and Results:

Widely used instrumentations in small gauge vitrectomy have a limitation in the treatment of pathologic myopia-related complications. The extremely long axial elongation may hinder the instrumentations from getting close enough to the retina. Excessive compression of the globe with lowering the intraocular pressure may allow a closer approach to the retina, although the corneal distorsion may induce poor visualization of retina. The surgeon may achieve extra millimeters to approach the retina with removal of trocars during surgery. Perfluorocarbon liquid (PFCL) is a widely used as an intraoperative tool. However, it may be difficult to visualize transparent PFCL clearly in cases with severe chorioretinal atrophy at the posterior pole. Triamcinolone acetonide enables visualization of residual PFCL intraoperatively, and then it is useful at the end of vitrectomy to ensure that residual PFCL is removed completely. In complex cases, the surgical procedures may induce dehiscence of conjunctiva that may lead to postoperative sclerotomy leakage. Thermal cauterization of the conjunctiva may be used to close the conjunctival wound and prevent sclerotomy leakage.


The surgical tips for small gauge vitrectomy may be useful to handle technical difficulties in the treatment of pathologic myopia-related complications.