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    Clinical Round Up: No glaucoma protection from primary IOL placement in children


    When viewing optical coherence tomography (OCT) images, she advised surgeons to look at the deepest side of the staphyloma because that is the site where the lesions are present.

    “It is the sclera that progressively detaches from the retina and not vice versa in highly myopic eyes,” said Dr. Parolini. “In fact, myopic traction maculopathy is a series of complications secondary to anteroposterior traction in eyes with posterior staphyloma.”

    In these cases of posterior staphyloma, the natural history may be development of macular schisis and progression to a retinal detachment without a macular hole.

    Regarding OCT, she also advised looking at long OCT scans of at least 12 mm.

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    “Compared with shorter scans, only the long scans show the entire profile,” she said.

    An important concept, Dr. Parolini pointed out, is that the staphyloma in adults with high myopia progresses over time. She described a group of patients with high myopia who were followed by Japanese ophthalmologists for more than 20 years. As an example, a 42-year-old woman with a refractive error of -22 D had an axial length of 31.9 mm and by age 68 years, that axial length had increased to 33.3 mm.

    Brian Curtin, MD, first classified Staphylomas in 1977, based on the location of the staphyloma.

     “However, now we know that this is not a static, but rather a dynamic classification,” Dr. Parolini said. For example, a staphyloma classified as a type II staphyloma in a young patient can become a type IX over years with progression nasally and temporally to the optic nerve.

    Because of this, there is a need to stop the progression behind the macula and the complications associated with progression, she added.

    To address this issue, she has been working on a new design, specifically, an L-shaped macular buckle, to treat these patients.

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    In this procedure, a titanium stent is inserted into a 3-cm-long silicone sponge that is bent at a 90-degree angle to form long and short arms. The short arm is inserted in the superotemporal quadrant along the lateral rectus muscle, and then a fiberoptic is inserted into the short arm and is placed behind the macula.

    The buckle is sutured anteriorly close to the insertion of the lateral rectus muscle.

    “The buckle is very accessible and the surgery is easy to perform,” she said.

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