Scleral Indentation Technique Helps Overcome ILM Peeling Challenges in High Myopia


Sabti K. How to overcome surgical challenges in HD myopes with very long axial length? Presented at: World Retina Congress; May 12-15, 2022; Fort Lauderdale, Florida.

Disclosures: Sabti does not report any relevant financial information.

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FORT LAUDERDALE, Fla. – A scleral indentation technique allows for safe and comfortable peeling of the internal limiting membrane, or ILM, in highly myopic eyes using regular forceps.

“ILM peeling in highly myopic eyes is technically challenging. Staining is poor, visibility is limited, and the ILM is friable in some cases. The standard forceps are often difficult to use if the axial length is greater than 27 mm and impossible if it is greater than 28 mm. Iatrogenic damage to the retina may occur when grasping and re-grasping the membrane”, Khalid Sabti, MD, FRCS, told the World Retina Congress.

Khalid Sabti

Longer-stemmed forceps may be the best option for membrane peeling in high myopes, but the choice is limited and not all surgeons may have them in their arsenal.

In the absence of these forceps, Sabti suggested a bimanual technique which he used successfully in three difficult cases with large axial lengths. A 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 further…you bring it to 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 scleral buckling retractor to indent the sclera.

Another advantage of this technique is in the presence of staphyloma, when the angle of approach would be difficult for any forceps, increasing the risk of trauma.

“To sum up, the posterior scleral indentation temporarily shortens the myopic eye and allows us to perform 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 surgeries using other instruments such as cautery and scissors,” Sabti said.

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