A novel surgical technique for macular manipulation in highly myopic eyes with long axial length

Purpose: We developed a novel surgical technique tailored for highly myopic eyes characterized by extended axial lengths. Myopic eyes are prone to macular complications including macular schisis, full-thickness macular holes, and retinal detachment, which can cause severe vision loss. A pars plana vitrectomy is necessary in these cases. However, due to the considerable distance between the posterior pole and the cannula, regular forceps cannot reach the macula in some cases. To overcome this, we inserted a trocar more posteriorly after localizing the ora serrata. Methods: First, we placed two ports and performed partial vitrectomy without the infusion of balanced salt solution (BSS) to reduce the intraocular pressure. Subsequently, we observed the peripheral retina localized to the ora serrata by scleral indentation using forceps. Following the precise marking of the area, a third trocar was inserted and its position and placement confirmed intraoperatively. Results: Surgical maneuvers including a removal of the internal limiting membrane were safely performed using regular forceps through the posteriorly located cannula. Conclusions: The described technique offers a solution to the challenges posed by the extended axial lengths of highly myopic eyes during vitreoretinal surgery. By inserting the trocar more posteriorly, surgeons can enhance accessibility to the macula without requiring specialized equipment or extensive maneuvers.