Central detachment with myopic hole in extreme myopia

Gentlemen (& ladies),

I did an extreme myope -18 D, phakic with a posterior central detachment and a macular hole. Careful peripheral indented search showed no other holes. I thought I had induced a PVD, but on injecting dilute Triamcinolone realised that there was a very thin sheet of adherent vitreous still there, this was very resistant to come off, and had to be scraped off with a Tano Diamond dusted scraper. Yasou Tano has shown these cases in the past at various meetings, so I had an idea of what needed doing. Having cleared the vitreous and adherent hyaloid to the equator (at least), I decided to do a mid periphereal retinotomy to flatten the retina and then used brilliant peel (blue)under air hoping to stain ILM and remove it. PFCL fill after retina is flat under air, but when I put contact lens on to try and focus on ILM, I just could not get it to focus! Tried to peel ILM through BIOM view - I think with partial success. Laser to retinotomy and an area of 'suspicious' retina peripherally, then direct PFCL to silicon oil exchange. Let us see how she does.

I will try to make the time to edit the video and post it on my blog over the next few days - so watch this space

Som