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Table 1 Traditional and novel techniques to deal with issues related to high myopia

From: Vitrectomy in high myopia: a narrative review

Issues Traditional techniques Novel techniques
Increased axial length Increased distance between sclerotomies Ad hoc straight or curved instruments
Use of 20-G instruments  
Removal of trocars  
Epiretinal tissues visualization Chromovitrectomy iOCT
Filters 3D
Dye toxicity Place a substance over the fovea (e.g. PFCL, sodium hyaluronate, autologous blood) Devices to inject gently the dye (Drip dropper, SideFlo cannula)
Filters iOCT
ILM peeling Start at least 1 DD from the fovea Diamond Dusted Membrane Scraper
Start from temporal or inferior quadrants FINESSE Flex loop
Elevate preexisting edge using the back of a needle, a MVR blade or vertical scissors  
PFCL bubble to stabilize retina  
Lift the flap a bit more than usual  
MH closure ILM non-peeling Inverted ILM flap (complete, 270° temporal C-shaped variant, 180° superior variant, Viscoat-assisted)
ILM peeling Injection over the hole of autologous platelet-rich plasma, autologous transplantation of ILM membrane, lens capsular flap, neurosensory retina
Shaving vitreous base in eyes with clear lens Choice of instruments (valved trocars, small G instruments) Non-contact wide field viewing systems
Trocar insertion at 4 mm Ad hoc curved instruments
Peripheral indentation Brush the peripheral retina (Diamond Dusted Membrane Scraper, FINESSE Flex loop)
Hand switching  
Bending of standard instruments  
Sclerotomy leakage Biplanar scleral insertion Triplanar scleral insertion
Wound construction (Longer tunnel, narrow angle of insertion, parallel to the limbus, bevel-down incision) 27-G instruments
Sclerotomy massage Other techniques to close the wound (releasable sutures, tissue glue, polyethylene glycol-based hydrogel bandage, conjunctival cauterization
Transconjunctival and transcleral absorbable suture  
  1. G gauge, iOCT intraoperative optical coherence tomography, 3-D three-dimensional, PFCL perfluorocarbon liquid, ILM inner limiting membrane, DD disc diameter, MH macular hole