Pathologic Myopia with Staphyloma, Macular Hole, and Macular Detachment

This patient has a staphyloma - a bulging outward of the back of the eye. The retina is stretched and can develop a macular hole (blue arrow). Liquefied vitreous flows through the macular hole and causes a macular detachment (border noted by green arrows). Pathologically myopic eyes often have tilted disks as shown in this case (black arrow). This appearance is caused by the optic nerve inserting into the sclera at an angle other than 90 degrees to the tangent of the scleral surface. The treatement is vitrectomy, peeling of the internal limiting membrane, and intraocular tamponade with either gas or silicone oil. If silicone oil is used, it must be removed at a second operation usually 1-2 months later. If gas is used, it will be exhaled with the patient's respirations over 2-3 weeks and the eye fills with physiologic salt solution made by the eye.