(1)
St. Johns, FL, USA
(2)
Helen Keller Foundation for Research and Education, International Society of Ocular Trauma, Birmingham, AL, USA
(3)
Consultant and Vitreoretinal Surgeon, Milos Eye Hospital, Belgrade, Serbia
(4)
Consultant and Vitreoretinal Surgeon, Zagórskiego Eye Hospital, Cracow, Poland
42.1 The Risk of RD If Cataract Surgery Is Needed
One crucial question in these patients is the development of a cataract, whose removal further increases the RD risk: what is the safest management option? There are three alternatives to choose from:
The traditional approach. Standard phacoemulsification and IOL placement are performed, even if the IOL has 0 D power (see Table 3.3). This option completely neglects the RD risk.1
The traditional approach + laser cerclage. At least 1 month before the cataract is removed, the anterior retina is treated (see Sect. 30.6) to counter the existing and forthcoming traction. The problem is that the cataract may interfere with visualization and thus the completion of the treatment; furthermore, the laser scars may not be sufficient to resist the VR traction. Nevertheless, this option reduces the RD risk compared to the traditional approach.
The unorthodox approach: lensectomy, vitrectomy, and endolaser cerclage. This is by far the most complex operation and one with an obvious risk for postoperative PVR development. However, once the PVR threat is over,2 the risk of RD will be as close to zero as possible. IOL implantation may not be needed at all,3 but if an IOL is implanted, the surgeon should consider the option of removing the capsules and implanting an iris-claw IOL (see Chap. 38).
42.2 Vitrectomy in the Highly Myopic Eye
The larger axial length has important implications for the VR surgeon (see Table 42.1).
Table 42.1
The highly myopic eye and the VR surgeon
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