LAUSR

Supplemental Digital Content is Available in the Text. In high myopic eyes with axial lengths >34 mm, indenting the posterior scleral wall with Helvoston retractor to elevate the macula reduces the sclerotomy-–retinal surface distance. This allows standard-size intraocular instruments to be used for surgical maneuvers such as internal limiting membrane peeling, fluid–air exchange, and the use of endocautery and scissors. Purpose: To assess a novel surgical technique to perform macular surgery in high myopic eyes, with axial lengths >34 mm, where standard-size intravitreal surgical instruments cannot reach the retinal surface during pars plana vitrectomy for internal limiting membrane peeling in myopic macular holes. Methods: Five eyes with axial length >34 mm were included in this study. A 7-mm Helvoston retractor was placed under Tenon capsule and guided along the eyeball until an elevation was noticed on the macular area. This elevation shortened the operating distance, temporarily, between the sclerotomy and retinal surface, enabling the use of standard-size intraocular instruments. Preoperative vision and optical coherence tomography were compared with postoperative data and used as markers of anatomical and functional success. Results: Vision improvement and anatomical closure of the macular hole with reattachment of the retina was achieved in all five eyes. No surgical complications associated with this surgical technique were noticed. Conclusion: Indenting the macular area from behind the eye globe with a 7-mm Helvoston retractor in a high myopic eye with axial length >34 mm during pars plana vitrectomy is safe and makes surgical procedures, such as internal limiting membrane removal, easier.