An Intraoperative Stream of Subretinal Fluid Reveals an Occult Juxtapapillary Microhole in Pathologic Myopia: A Case Report

Introduction

Juxtapapillary microholes are an uncommon cause of rhegmatogenous retinal detachment (RRD) in pathologic myopia and can be difficult to detect within extensive peripapillary atrophy (PPA). We describe a case in which an intraoperative fluid stream led to identification of the causative juxtapapillary microhole. Case Presentation: A 72-year-old woman with high myopia presented with blurred vision and a visual field defect in the left eye. Fundus examination showed posterior staphyloma, extensive PPA, and retinal detachment involving the posterior pole, but no peripheral retinal break or macular hole was identified. During pars plana vitrectomy, a narrow fluid stream was seen repeatedly arising from the inferior PPA during aspiration with the vitrectomy probe. Higher-magnification examination disclosed a small, round juxtapapillary microhole. A free internal limiting membrane (ILM) fragment was inserted into the break, followed by fluid-air exchange and silicone oil tamponade. The retina reattached, and OCT showed the ILM fragment at the break site. Silicone oil was removed approximately 14 months later, followed by C3F8 gas tamponade. At the most recent follow-up in June 2026, the retina remained attached on scanning laser ophthalmoscopy.