The author describes a customized posterior scleral reinforcement, its manufacturing method, the rationale of its therapeutic effect, and the surgical technique of its implantation. A 54-year-old female patient with a case history of myopic macular hole with retinal detachment and posterior staphyloma, refractory to pars plana vitrectomy and peeling of internal limiting membrane, underwent posterior scleral reinforcement treatment. Retinal reattachment and macular hole closure were obtained. Best corrected visual acuity increased from light perception to 20/160 Snellen. The pars plana vitrectomy is mandatory to remove vitreoretinal tractions and epiretinal membranes; furthermore, the internal limiting membrane peeling makes retina less rigid. However, it may not be sufficient to allow retinal reattachment and it plays no preventive role in limiting posterior staphyloma progression. The rationale of posterior scleral reinforcement is to reduce retinal stretching, to contain posterior staphyloma, and to limit its progression over time.
Macular hole with central retinal detachment in high myopia with posterior staphyloma.
