Search

PURPOSE To investigate morphologic features along posterior staphyloma edges in eyes with pathologic myopia using ultra-widefield optical coherence tomography imaging. METHODS Highly myopic patients (refractive error < -8 diopters or axial length ≥26.5 mm) were consecutively examined by prototype ultra-widefield optical coherence tomography with a scan width of 23 mm and depth of 5 mm. Staphyloma edges were assessed for scleral, choroidal, and retinal status, as well as measurements of angle size. Findings were correlated with pigmentary changes observed on Optos fundus photography, and multivariate logistic regression analyses were performed. RESULTS In 164 eyes diagnosed with posterior staphyloma by ultra-widefield optical coherence tomography, choroidal thinning and scleral protrusion were hallmark features of staphyloma edges, observed simultaneously in more than 95% of staphylomatous eyes. Outer neural retinal thinning was observed in 80 eyes (48.8%), whereas 15 eyes (9.1%) showed retinal pigment epithelium damage. The mean angle at the staphyloma edge was 23° ± 12.4° (range 8° to 77°). Larger angles were significant predictors of retinal thinning (adjusted odds ratio: 1.17, confidence interval: 1.09-1.25), and the staphyloma was detected by Optos pseudocolor fundus photography (adjusted odds ratio: 1.08, confidence interval: 1.02-1.15). CONCLUSION These morphologic findings may provide a basis for exploring the natural evolution of posterior staphyloma as part of the development of pathologic myopia.

To analyze clinical characteristics in eyes with myopic traction maculopathy (MTM).Nine hundred and ninety-one patients (1,334 eyes) with MTM, who visited Zhongshan Ophthalmic Center from January 2014 to December 2019, were involved. Myopic traction maculopathy was classified into six grades according to the new classification system: no macular schisis (T0), inner or outer foveoschisis (FS) (T1); inner and outer FS (T2), foveal detachment (T3), full-thickness macular hole (T4), and macular hole retinal detachment (T5).Seven hundred and seventy-eight (58.32%) eyes were in T0, 157 (11.77%) in T1, 177 (13.27%) in T2, 129 (9.67%) in T3, 45 (3.37%) in T4, and 48 (3.67%) in T5. With the severity of MTM, age increased and the best-corrected visual acuity became worse (P0.001). However, no significant differences were found on spherical equivalent refraction or axial length among different grades of MTM (P0.05). Moreover, significant differences on best-corrected visual acuity, spherical equivalent refraction, axial length, and staphyloma rate existed between eyes with inner FS and eyes with outer FS (P0.01), but not between eyes with outer FS and eyes with both inner FS and outer FS (P0.05). Besides, significant differences were found on spherical equivalent refraction, axial length, and staphyloma rate between full-thickness macular hole with and without macular schisis (P0.001).Spherical equivalent refraction and axial length were not correlated with the severity of MTM in this cohort. It might be preferable to categorize eyes with outer FS and eyes with both inner FS and outer FS as a same grade. Potential difference in the pathogenesis between full-thickness macular hole with and without macular schisis might exist.

PRCIS Postoperative suprachoroidal hemorrhage (PSCH) is an infrequent but devastating complication after nonvalved aqueous drainage implant surgery and demonstrated a bimodal distribution. The final outcomes of either conservative management or surgical drainage of the hemorrhage remained poor. PURPOSE The aim was to report the incidence and outcomes of eyes developing PSCH after undergoing Aurolab aqueous drainage implant (AADI) surgery for adult and pediatric refractory glaucomas. MATERIALS AND METHODS In this retrospective series, case files of all patients who underwent AADI between May 2012 and December 2019 were retrieved from an electronic database. A PSCH was defined as the presence of hemorrhagic choroidal detachment, confirmed by ultrasound B scan, occurring in a closed system in the postoperative period. RESULTS Of the 986 eyes that underwent AADI during the study period, 7 (0.7%), developed PSCH (95% confidence interval=0.3-1.6%). There were no differences in the preoperative parameters between those with and without PSCH. Of these, 4 were seen in pediatric eyes (4/288, 1.4%) and 3 in adult eyes (3/698, 0.4%) (P

PURPOSE To describe the off-label use of lyophilized equine pericardium for tectonic enhancement of the sclera in a case of progressive scleromalacia perforans. METHODS An 82-year-old woman with a history of varicella zoster virus sclerokeratitis presented with a progressively expanding scleral thinning at the superonasal quadrant of the anterior sclera of her left eye. The eye was blind because of intractable glaucoma. To avoid perforation of the exposed choroid, a single layer of lyophilized equine pericardium was sutured over the scleral perforation. After performing a conjunctival peritomy in the involved superonasal area, the pericardium was trimmed, fixated on the anterior sclera with 4 Nylon 9 to 0 interrupted sutures, and tucked underneath the conjunctival pocket. The conjunctiva was adapted with 6 Vicryl 8 to 0 interrupted sutures. RESULTS The postoperative course was uneventful. At 12 months after surgery, slit-lamp biomicroscopy showed a stable subconjunctival sheet covering the staphyloma, whereas anterior segment optical coherence tomography demonstrated thickening of the ocular wall, suggesting successful integration of the pericardium. CONCLUSIONS Suturing of equine pericardium over a scleral defect was feasible allowing successful reinforcement of the staphyloma in a case of severe scleromalacia perforans.

Purpose To investigate the relationship between dome-shaped maculas (DSMs) and posterior staphylomas in highly myopic eyes. Methods Five hundred and eleven eyes of 291 patients with high myopia (refractive error ≤-8.0 diopters or axial length ≥26.5 mm) were examined by ultra-widefield swept-source optical coherence tomography (UWF-OCT). Posterior staphylomas were identified by detecting the staphyloma edges in the UWF-OCT images. Results Eighty-two eyes of the 511 highly myopic eyes had a DSM, and a posterior staphyloma was observed in 45 of 82 eyes with a DSM (54.9%) and in 301 of 429 eyes (70.2%) without a DSM. The incidence of staphylomas was significantly lower in eyes with a DSM than those without a DSM (P = 0.007). The wide macular type of staphyloma was the predominant type in eyes with a DSM (31/45 eyes; 68.9%), whereas the narrow macular type and wide macular type of staphylomas were present almost equally in the eyes without a DSM. Conclusion The lack of staphylomas in 45% of eyes with a DSM suggests that DSMs form independently from posterior staphylomas. Dome-shaped maculas tend to occur in eyes with a large expansion of the posterior fundus and should be considered a posterior scleral curvature abnormality.

PURPOSE To report a rare case of morning glory disk anomaly with a contractile optic disk and a peripheral avascular retina along with detailed spectral domain optical coherence tomography characteristics of the contractions. METHODS Serial fundus photographs and optical coherence tomography images were taken to study the characteristics of optic disk contractions. Fundus fluorescein angiography was performed to delineate the peripheral avascular retina in the same eye. RESULTS A 9-year-old boy presented to us with morning glory disk anomaly in the left eye. He had contractile motions of the optic disk around two to three times in a minute, with each contraction lasting for 4 seconds to 5 seconds. Serial spectral domain optical coherence tomography images could depict an anterior contraction of the optic disk along with the surrounding peripapillary staphyloma with no evidence of any subretinal fluid. Fundus examination of the left eye also suggested the presence of an avascular retina temporally, which was confirmed on fundus fluorescein angiography. CONCLUSION Our report provides detailed spectral domain optical coherence tomography images through the optic disk in morning glory disk anomaly during various phases of optic disk contractions. It also presents a second rare association of a peripheral avascular retina in the case.

Supplemental Digital Content is Available in the Text. This study utilized 3D magnetic resonance imaging in combination with optical coherence tomography to investigate the relationship between dome-shaped macula and posterior staphyloma in high myopic eyes., Purpose: To investigate the relationship between posterior staphyloma and dome-shaped macula (DSM) in highly myopic eyes. Methods: The clinical data were collected from patients with high myopia: diopter, best-corrected visual acuity, axial length, fundus images, optical coherence tomography, and 3D magnetic resonance imaging. A DSM was defined as a convex curvature of the macula in one or both of the vertical and horizontal optical coherence tomography scans. The relationship between DSM and posterior staphyloma was evaluated. Results: A total of 123 eyes were included. Dome-shaped macula was found in 18 eyes (14.63%). Twelve eyes with DSM had positive 3D magnetic resonance imaging findings. Nine eyes had horizontal oval-shaped dome, and a band-shaped inward convexity that extended horizontally from the optic disc through the fovea could be seen. Three eyes had round dome, and 3D magnetic resonance imaging showed a round inward convexity of the macular area. Five inward convexities were the border of multiple staphylomas, five were the boundary of one staphyloma, and two were within a single staphyloma. Conclusion: The formation of highly myopic DSM is related to the morphological change of the entire posterior segment.

Purpose Pigmentary alterations along the presumed edge of staphyloma in wide-field fundus images have been reported to be highly correlated with the eye shape in three-dimensional magnetic resonance images. The purpose of this study was to analyze Optos images in a large series of highly myopic patients to determine the prevalence, types, and features of staphylomas. Methods One thousand and sixty eyes of 541 patients with high myopia (axial length ≥ 26.5 mm) in at least one eye were retrospectively analyzed in Japan and Spain. To determine the presence and types of staphyloma, the authors focused on pigmentary abnormalities along the presumed edge of staphylomas with at least one positive finding in fundus images, autofluorescent images, and infrared images by Optos. Results Posterior staphyloma was detected in 552 of 1,060 eyes (55%) in Optos images. Wide macular type was the most common (79%), followed by narrow macular (15%), then peripapillary (3%), inferior, and finally nasal. In the 60 non-highly myopic eyes of patients with unilateral high myopia, staphyloma was detected in 40%, suggesting that unilateral high myopia might be a bilateral disorder with marked differences in the degree of staphyloma between the two eyes. Combined staphylomas such as the peripapillary type within the wide macular type were also found. Conclusion Posterior staphyloma was found in 55% of 1,060 eyes with bilateral or unilateral pathologic myopia. Wide macular was the most common type, although there were much more variations in the shape of staphylomas than that had been previously believed.

PURPOSE To assess the influence of tilted disk syndrome (TDS) and inferior staphyloma on the macular clinical expression of MFC. METHODS Medical charts of patients with MFC examined since 2009 were reviewed retrospectively. All patients underwent standard examination and multimodal imaging including fundus color photography, fundus autofluorescence, and spectral domain optical coherence tomography. Two groups of patients were compared : Group 1 with TDS and inferior staphyloma and Group 2 without. The number of MFC spots were counted and normalized to the surface area in a circle centered about the fovea. In Group 1, the number of lesions inside the staphyloma was compared with that outside the staphyloma. RESULTS At baseline, 8 eyes in Group 1 had a mean (±SD) higher number of chorioretinal lesions outside the staphyloma (14.5 [±7.2]) than within the staphyloma (5 [±5.5]) (P = 0.017). All 11 eyes in Group 2 had chorioretinal lesions homogeneously distributed in the posterior pole. Eyes with TDS and inferior staphyloma developed choroidal neovascularization more frequently (6/8 eyes) than eyes without TDS (5/11 eyes) (P = 0.026). CONCLUSION Inferior staphyloma associated with TDS could modulate the clinical expression of the inflammatory and neovascular process in eyes with MFC.

Rationale: Treatment of macular hole retinal detachment (MHRD) in patients with pathologic myopia may require multiple surgeries due to the risk of surgical failures or recurrences. Intravitreal silicone oil injection before an additional surgery may be another option for recurrent MHRD in aphakic eyes, but this procedure is rarely performed. Patient concerns: A 69-year-old man visited the hospital with a chief complaint of metamorphopsia in his right eye for 5 days. The right eye had undergone a cataract extraction 5 years prior and an Nd:YAG laser capsulotomy 1 year prior. The axial length was 36.18 mm; the fundus examination and optical coherence tomography (OCT) revealed inferior retinal detachment with a macular hole involving the posterior pole. Pars plana vitrectomy (PPV) with internal limiting membrane (ILM) peeling, endolaser photocoagulation, and silicone oil tamponade were performed. Five months after the surgery, the retina was detached, and a macular hole was observed. Diagnosis: Recurrent MHRD in a patient with pathologic myopia. Intervention: PPV with ILM peeling, endolaser photocoagulation, and silicone oil tamponade at the initial visit and additional intravitreal silicone oil injection (0.5 ml) at follow-up visits. Outcomes: The retina was well-attached until 5 months after the additional intravitreal silicone oil injection. Lessons: Additional intravitreal silicone oil injection can be a good option for treating MHRD in aphakic eyes if the detachment of the retina is dependent on posturing. The surgeon should consider the volume of silicone oil or postoperative posturing in the treatment of MHRD.

In the article “Teaching NeuroImages: Morning glory disc anomaly,” Dr. Poillon et al. presented a case of a 7-month-old girl with strabismus who was diagnosed with a morning glory disc anomaly (MGDA) in the right eye and found to have a glial tuft at the optic nerve insertion. In response, Drs. Karimi and Sanjari argue that the image depicted appears to be a peripapillary staphyloma and not MGDA. They note the importance of making this distinction because vision can be preserved aside from an enlarged blind spot in the setting of a peripapillary staphyloma. Replying to these comments, Drs. Lecler and Poillon acknowledge the importance of differentiating between the 2 conditions but highlight 2 important features that supported their diagnosis of MGDA—the radial aspect of the retinal vessels on fundoscopy and the presence of abnormal tissue at the optic nerve insertion on ultrasound and MRI—neither of which would be expected with a peripapillary staphyloma. They note that their diagnosis was confirmed by the French National Center of Reference for MGDA and report that a retinal detachment occurred in the first year of follow-up, further supporting the diagnosis. In the article “Teaching NeuroImages: Morning glory disc anomaly,” Dr. Poillon et al. presented a case of a 7-month-old girl with strabismus who was diagnosed with a morning glory disc anomaly (MGDA) in the right eye and found to have a glial tuft at the optic nerve insertion. In response, Drs. Karimi and Sanjari argue that the image depicted appears to be a peripapillary staphyloma and not MGDA. They note the importance of making this distinction because vision can be preserved aside from an enlarged blind spot in the setting of a peripapillary staphyloma. Replying to these comments, Drs. Lecler and Poillon acknowledge the importance of differentiating between the 2 conditions but highlight 2 important features that supported their diagnosis of MGDA—the radial aspect of the retinal vessels on fundoscopy and the presence of abnormal tissue at the optic nerve insertion on ultrasound and MRI—neither of which would be expected with a peripapillary staphyloma. They note that their diagnosis was confirmed by the French National Center of Reference for MGDA and report that a retinal detachment occurred in the first year of follow-up, further supporting the diagnosis.

Purpose To evaluate the efficacy of supra choroidal buckling procedure using a supra choroidal catheter, as a new approach in treating myopic vitreomacular interface disorders specially in difficult cases of myopic traction maculopathy with or without macular hole retinal detachment in posterior staphyloma depending on the concept of indenting the choroid only, from a 1-year data study. Methods A newly developed supra choroidal catheter was used to deliver stabilized, cross-linked, long-acting hyaluronic acid as a filler in the supra choroidal space in the area of the staphyloma forming a choroidal indenting effect. Before the injection, pars plana vitrectomy was performed without internal limiting membrane peeling to avoid the risk of break of the roof of foveal detachment in case of foveoschisis. This indentation was used to treat 11 patients with myopic foveoschisis and 12 patients with myopic macular hole retinal detachment, 5 of whom had failed primary repair by vitrectomy before inclusion in this trial. Clinical and optical coherence tomographic evaluations of these patients were performed over 1-year follow-up. Results Retinal layer restoration was achieved in all 11 eyes with myopic foveoschisis. This was gradual over a period of 2 to 6 weeks postoperatively. No recurrence over the 12-month follow-up was observed. Visual acuity improved by 1 line or more in 9 eyes (81.8%). Of the 12 eyes, 10 with macular hole detachment (83%) showed closure of the holes in association with the resolution of the detachment; 2 eyes showed resolution of the detachment and flatting of the edge of the holes but with incomplete closure on optical coherence tomography. Eight eyes (66.6%) showed improvement in visual acuity by 1 or more lines with no recurrence of retinal detachment over the 12-month follow-up period. The indentation effect was sufficient over the 12-month follow-up period. Conclusion The indentation effect achieved by supra choroidal approach can be used as a method of managing myopic foveoschisis and myopic macular hole with detachment even in eyes with failed primary vitrectomy, counteracting the role of posterior staphyloma in the role of the disease. The indentation effect is sufficient for first year of follow-up.

To clarify the nature of submacular choroidal neovascularization (CNV) and underlying choroidal circulatory disturbances in tilted disk syndrome.We retrospectively examined patients with submacular CNV associated with tilted disk syndrome using fluorescein angiography and indocyanine green angiography in this observational case series. The axial lengths were measured by ultrasonography. Eyes with myopia exceeding -6.0 diopters were excluded.Eleven consecutive eyes (mean patient age ± standard deviation, 60.5 ± 12.1 years) were included. The axial lengths ranged from 21.7 mm to 24.6 mm (mean, 23.61 ± 0.95 mm). Classic CNV in nine eyes and polypoidal choroidal vasculopathy in two eyes developed at the macula along the superior margin of the inferior posterior staphyloma that crossed the macula in all eyes. The superior margin of the inferior posterior staphyloma was hyperfluorescent on fluorescein angiography and hypofluorescent on indocyanine green angiography, with the latter larger than the former. The inferior staphyloma contained fewer and smaller choroidal arteries and veins. During follow-up, the submacular CNV and polypoidal choroidal vasculopathy spontaneously regressed and the subretinal hemorrhage resorbed, leaving a fibrotic scar in eight eyes. Newly developed CNV at the initial no-leakage site on fluorescein angiography developed in one eye and the CNV located in the area of band-shaped hypofluorescence on indocyanine green angiography.Stretching of the ocular wall might result in occluded choriocapillaris and degeneration of the retinal pigment epithelium. These changes along the border of the inferior posterior staphyloma predispose to submacular CNV and polypoidal choroidal vasculopathy in tilted disk syndrome.

Purpose To analyze the anatomical features of peripheral staphyloma and evaluate the clinical effects of double lamellar keratoplasty on this eye disease. Methods Four cases of peripheral staphyloma were treated by double lamellar keratoplasty. One third of the degenerative iris was excised, and the iris was returned into the anterior chamber. Perforation was repaired using a very thin layer of lamellar graft, 1 mm larger than the perforation, after which the anterior chamber was filled with buffered salt solution to check if there was any leak from the graft edge. If there was, the graft was resutured and reexamined. When there was no leak, one more lamellar graft was transplanted to treat the ulcer. Results All patients presented a funnel-shaped corneal ulcer with a perforation at the bottom. The iris bulged out from the perforation like a balloon, becoming large with the elevated intraocular pressure. Postoperatively, the anterior chamber returned to its normal structure without anterior synechia. Useful vision was protected, and 3 patients had improved visual acuity. Conclusions Peripheral staphyloma has similar morphological and anatomical structures with hernia. Double lamellar keratoplasty, which involves returning the iris into the anterior chamber, repairing the perforation, and transplanting a second lamellar graft, seems to be effective in the treatment of peripheral corneal staphyloma.

PURPOSE To describe the clinical characteristics of macular complications on the border of an inferior staphyloma associated with tilted disk syndrome. METHODS We reviewed retrospectively the medical records of 32 consecutive eyes of 20 patients with tilted disk syndrome and an inferior staphyloma lying across the macula. RESULTS In 21 (66%) eyes, fluorescein angiography showed window defects on the border of the staphyloma, where the early phase of indocyanine green angiography showed hypofluorescence due to atrophy of the choriocapillaris. On the late phase of indocyanine green angiography, 19 eyes (59%) showed hyperfluorescence along the border of the staphyloma, which often extended beyond the area of the window defect. Of the 32 eyes, 25 (78%) had macular complications: polypoidal choroidal vasculopathy in 7 (22%), classic choroidal neovascularization in 1 (3%), focal serous retinal detachment without polypoidal choroidal vasculopathy or choroidal neovascularization in 13 (41%), and atrophy of the retinal pigment epithelium alone in 4 (13%). Visual acuity in eyes with polypoidal choroidal vasculopathy or choroidal neovascularization was significantly worse than that in eyes with other complications (P < 0.001). CONCLUSIONS Eyes with tilted disk syndrome often have macular complications on the border of the inferior staphyloma, which can cause severe visual loss.

PURPOSE To report a case of asymmetric retinopathy of prematurity associated with a peripapillary staphyloma. METHODS Case report. RESULTS A 1,545-g male infant was born at 34 weeks' gestation. He was noted on initial examination to have a peripapillary staphyloma in the left eye and immature retinal vasculature in zone 2 of both eyes. Follow-up examination at 16 weeks of age showed a normal right eye with full vascularization and zone 2, stage 2 retinopathy of prematurity in the left eye. CONCLUSION To our knowledge, this is the first reported case of peripapillary staphyloma in which only the affected eye developed retinopathy of prematurity.

PURPOSE Although conjunctival rhinosporidiosis is endemic in India, associated scleral melting and staphyloma formation are quite rare. We report clinical features and management in three patients with this unusual presentation. METHODS Retrospective review of case records of three patients with conjunctival rhinosporidiosis. RESULTS Infection occurred in young, healthy adults and was localized to the forniceal conjunctiva in all patients. The affected conjunctiva had numerous grey-white spherules, but a polyp-like lesion was not present in any patient. Diagnosis was based on clinical features and examination of scrapings from the involved conjunctiva. Treatment was surgical, with excision of infected conjunctival tissues and staphyloma repair with homologous sclera or autogenous periosteum. Failure to recognize the conjunctival pathology in one patient resulted in recurrence of the staphyloma. CONCLUSION Conjunctival rhinosporidiosis can be associated with scleral staphyloma in young, healthy, adults. Differentiating this entity from idiopathic scleral ectasia requires knowledge of the clinical features of conjunctival rhinosporidiosis and a high index of clinical suspicion.

To determine the axial length distribution and prevalence of posterior staphyloma in a group of Saudi Arabian patients having cataract extraction.Tertiary care referral center.Approximately 75% of all cataract patients at the eye hospital have preoperative B-scan ultrasonography. The last 1000 B-scans performed for any reason were screened for patients having uncomplicated cataract surgery; 629 cases were included. The relationship between the presence of posterior staphyloma and patient age, sex, and axial length was studied.There were 371 (59.0%) men and 258 (41.0%) women with a mean age of 62.4 years +/- 15.7 (SD). Posterior staphyloma was identified in 67 patients (10.7%). The presence of staphyloma was not significantly related to patient sex or age. Although the mean axial length was significantly longer in eyes with staphyloma (27.43 +/- 2.36 mm) than in those without (23.18 +/- 1.64 mm), 9.3% of eyes without staphyloma had an axial length longer than 25.0 mm. No staphylomas were present in eyes with an axial length shorter than 23.3 mm. The longest axial length in an eye without a staphyloma was 32.5 mm.Posterior staphyloma was present in a high percentage of Saudi Arabian patients having cataract extraction.

PURPOSE To describe a new manifestation of Peters' anomaly. METHODS We managed four infants with an unusual form of Peters' anomaly. One eye of each patient had a thickened and scarred cornea, mimicking a corneal staphyloma, protruding anteriorly from the corneal plane. The other eye of each patient ranged from normal to having severe ocular anomalies. A corneal transplant was performed in each case. RESULTS Follow-up ranged from 1 to 3 years. Three eyes maintained graft clarity for at least 1 year. Each of these eyes developed vision. Two of these eyes developed glaucoma. The one eye with graft failure developed an inoperable retinal detachment. The histopathology of each corneal button showed changes consistent with Peters' anomaly. CONCLUSIONS These corneas demonstrated characteristics of both Peters' anomaly and congenital anterior staphyloma. Despite their severe anomalies, surgery successfully restored a more normal cosmetic appearance in all four eyes and vision in three eyes.

Background Tilted disk syndrome is a common condition that consists of inferonasal tilting of the optic disk and is usually associated with staphyloma in the inferonasal fundus. Case report We describe a 50-year-old woman whose fundus exhibited, in both eyes, all the characteristics of tilted disk syndrome but in an upside-down pattern: superior instead of inferior staphyloma and thinning of the retinal pigment epithelium, a superior instead of an inferonasal crescent, and an inferior instead of a superior visual field defect. Conclusion We have no satisfactory explanation for this unusual case.

Purpose To investigate the usefulness of transscleral diathermy for the treatment of retinal detachment due to breaks located at the posterior pole in areas of advanced chorioretinal atrophy or staphyloma in highly myopic eyes. Methods We reviewed the charts of seven consecutive patients who were operated on between 1984 and 1994 and for whom transscleral diathermy was used during intraocular retinal reattachment surgery to reduce posterior staphyloma. Mean refraction of the seven eyes was -24 diopters (range -16 to -35 diopters). Results After surgery, which included diathermy, the retina was reattached in six eyes (86%) that also had undergone vitrectomy and silicone oil tamponade, but remained detached in one eye (14%) that had undergone pneumopexy and diathermy; in this eye, the retina was subsequently reattached after vitrectomy and silicone oil injection. Silicone oil was removed from all seven eyes after a mean duration of 2.5 months. During a mean follow-up of 3 years, a recurrent retinal detachment developed in one eye 8 months after silicone oil removal. This retina was reattached after reinjection of silicone oil. Conclusions In the treatment of retinal detachment in highly myopic eyes, closure of posterior holes in areas of advanced chorioretinal atrophy or staphyloma can be achieved by transscleral diathermy in conjunction with vitrectomy and temporary silicone oil tamponade. The main benefit of transscleral diathermy results from its posterior pole scleral buckling effect due to shrinkage of the sclera.