Scleral indentation technique helps overcome challenges of ILM peeling in high myopia
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FORT LAUDERDALE, Fla. — A scleral indentation technique allows for safe and comfortable internal limiting membrane, or ILM, peeling in highly myopic eyes using regular forceps.
“ILM peeling in high myopic eyes is technically challenging. Staining is poor, visibility is limited, and the ILM is friable in some cases. Standard forceps are often difficult to use if the axial length is longer than 27 mm and impossible if it is longer than 28 mm. Iatrogenic damage to the retina may occur during grasping and regrasping of the membrane,” Khalid Sabti, MD, FRCS, said at the Retina World Congress.
Longer shaft forceps may be the best option for membrane peeling in high myopes, but the selection is limited, and not all surgeons may have them in their armamentarium.
In absence of those forceps, Sabti suggested a bimanual technique he has successfully used in three difficult cases with long axial lengths. Standard forceps can be used, while another instrument is introduced to depress or indent the posterior part of the eye and bring it closer to the forceps.
“Instead of reaching out farther away ... you bring it toward you and your instrument,” he said.
This technique has a learning curve, and bimanual skills are a prerequisite. Because there are no instruments specifically designed for this purpose, Sabti uses a retractor for scleral buckling to indent the sclera.
A further advantage of this technique is in the presence of staphyloma, when the angle of approach would be difficult for any forceps, increasing the chance of trauma.
“To summarize, posterior scleral indentation temporarily shortens the myopic eye and allows us to do surgery with minimal trauma, very comfortably, with our preferred forceps, regardless of [axial length]. We can perform complete peeling of even very large membranes, flatten staphylomas and also perform other surgical procedures by using other instruments such as cautery and scissors,” Sabti said.
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Sabti K. How to overcome surgical challenges in myopic MHs with a very long axial length? Presented at: Retina World Congress; May 12-15, 2022; Fort Lauderdale, Fla.
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