Retinal Detachment in High Myopia and Posterior Staphyloma

Dr Lee Shu Yen presented “Surgery in Atypical Situations: Retinal Detachment in High Myopia & Posterior Staphyloma” at the APVRS 2026 Congress in Gold Coast, Australia.

Her presentation covered the relationship between myopia and rhegmatogenous retinal detachment, features associated with pathologic myopia, and considerations when selecting and performing retinal detachment surgery.

The presentation stated that the risk of rhegmatogenous retinal detachment increases with the severity of myopia:

• Myopia between -1.00 and -3.00 dioptres: four times the risk of rhegmatogenous retinal detachment
• Myopia greater than -3.00 dioptres: ten times the risk
• High myopia: twenty times the risk compared with emmetropic eyes

Dr Lee also noted an increase in rhegmatogenous retinal detachments globally. Furthermore, more than 80% of phakic retinal detachments in people younger than 50 years occur in myopic eyes.

The reasons being:

• Posterior vitreous detachment occurring at a younger age in high myopia
• Highly myopic eyes are larger than low myopia eyeballs. The larger eyeballs are associated with higher incidence of lattice degeneration
• The need for cataract surgery at an earlier age in high myopia, together with a further increase in the risk of pseudophakic rhegmatogenous retinal detachment

Principles of Retinal Detachment Treatment

The presentation referred to Gonin’s principle: :

1. Identifying all retinal breaks
2. Sealing the retinal breaks
3. Relieving vitreous traction

Features Associated With Pathologic Myopia

Dr Lee described several features that may affect retinal detachment assessment and surgery in pathologic myopia.

Long Axial Length

A long axial length may be accompanied by thinning of the sclera, choroid and retina, as well as peripheral retinal degeneration.

Vitreous Changes

Abnormal relationships between the retina and the vitreous in the highly myopic eyes can make surgery challenging.

Retinal Breaks in Atypical Locations

Retinal detachments in pathologic myopia may not follow Lincoff’s rules. Retinal breaks may occur in locations including:

• Around retinal blood vessels
• At the edge of a posterior staphyloma
• Along the posterior edge of chorioretinal scars or areas of atrophy

Lattice degeneration and abnormal vitreoretinal relationships may also be present.

Procedure Selection Presented by Dr Lee

The presentation summarised the following considerations:

Technique	Situations listed in the presentation
Scleral buckle	Young and phakic patients
Pneumatic retinopexy	Patients unfit for an operation, following adequate assessment of the vitreous
Vitrectomy	Pseudophakic eyes and posterior retinal breaks
Vitrectomy combined with a buckle	Abnormal vitreoretinal relationships, a posteriorly inserted vitreous base, multiple rows of lattice degeneration with abnormal overlying vitreous, and phakic eyes

Concurrent Pathology

Highly myopic eyes are at risk of several complications which can occur in the same eye. These include myopic macula degeneration, myopic choroidal neovascularisation and glaucoma. 

Dr Lee presented a case involving an eye with -11.00 D of myopia and a history of myopic choroidal neovascularisation. The eye had received two anti-VEGF (ranibizumab) injections. Three months after the intravitreal injection, there was a sudden loss of vision that began with inferior visual-field loss and progressed upwards.

The eye was found to have a total retinal detachment arising from breaks at the 12, 7 and 8 o’clock positions, with surrounding scars. Circumferential preretinal membranes were present near the equator, together with a deep posterior staphyloma.

The patient underwent encirclage with a 41 band followed by  25-gauge pars plana vitrectomy and SF6 gas. The retinal detachment was fixed but there was a lmiit to the visual recovery due to foveal scar from the previous myopic choroidal neovascularisation.

Checking the Fellow Eye

Dr Lee concluded with a reminder to check the fellow eye as these are alfo highly myopic and thus at risk of potential complications.

About the Presentation

Presentation: Surgery in Atypical Situations: Retinal Detachment in High Myopia & Posterior Staphyloma
Speaker: Dr Lee Shu Yen
Event: APVRS 2026 Congress
Location: Gold Coast, Australia
Event dates shown: 25-30 August 2026

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