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Martin Charles, MD
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Martin Charles, MD, presents the case of a 39-year-old female patient who presented with low light perception due to diabetic proliferative retinopathy in her best eye. The pre-op OCT indicated a detached retina.
Dr. Charles decided to approach this case bimanually. Four valved trocar cannulas were inserted (three 27-gauge valved trocar cannulas and a single 25-gauge valved trocar cannula for a chandelier light).
Once in the eye, peripheral vitreous was removed with the Ultravit 7500cpm 27+ gauge vitrectomy probe (Alcon). Then, with the aid of the chandelier light, Dr. Charles dissects the fibrovascular membranes in a bimanual fashion (in one hand a 27+ gauge Grieshaber Advanced DSP Tip End Grasping Forceps connected to a Grieshaber Revolution Handle and in the other hand a Grieshaber 27+ Advanced DSP Tip straight Scissors connected to the new design Constellation Pneumatic DSP handpiece). He then used the Vitrectomy probe to aspirate pre-retinal hemorrhages and a laser probe to coagulate.
As illustrated in the video, the 7500cpm 27+ gauge vitrectomy probe helps to easily dissect the membranes and the tiny size of the instruments enables more precision than would have otherwise been capable with larger gauges.
While aspirating the pre-retinal hemorrhage with one hand, Dr. Charles performs endolaser photocoagulation with the laser probe in conjunction with raising the IOP to control the bleeding. Perfluorocarbon liquid is used to stabilize the retina in the posterior pole. A retinotomy is achieved with the vitreous cutter, air/fluid exchange is performed, and the subretinal fluid is drained through the retinotomy. Perfluorocarbon liquid is then aspirated and panphotocoagulation is accomplished with the 27-gauge curved laser probe. Air/silicone oil exchange is performed through the 25-gauge sclerotomy and air is vented through one of the 27-gauge valved trocar cannulas.
This patient improved from low light perception to 20/150 best corrected visual acuity at day 5. Here we can observe the wide fundus image at day 45 postop. Her vision improved even further to 20/100
Posted: 3/16/2015
Martin Charles, MD
Martin Charles, MD, presents the case of a 39-year-old female patient who presented with low light perception due to diabetic proliferative retinopathy in her best eye. The pre-op OCT indicated a detached retina.
Dr. Charles decided to approach this case bimanually. Four valved trocar cannulas were inserted (three 27-gauge valved trocar cannulas and a single 25-gauge valved trocar cannula for a chandelier light).
Once in the eye, peripheral vitreous was removed with the Ultravit 7500cpm 27+ gauge vitrectomy probe (Alcon). Then, with the aid of the chandelier light, Dr. Charles dissects the fibrovascular membranes in a bimanual fashion (in one hand a 27+ gauge Grieshaber Advanced DSP Tip End Grasping Forceps connected to a Grieshaber Revolution Handle and in the other hand a Grieshaber 27+ Advanced DSP Tip straight Scissors connected to the new design Constellation Pneumatic DSP handpiece). He then used the Vitrectomy probe to aspirate pre-retinal hemorrhages and a laser probe to coagulate.
As illustrated in the video, the 7500cpm 27+ gauge vitrectomy probe helps to easily dissect the membranes and the tiny size of the instruments enables more precision than would have otherwise been capable with larger gauges.
While aspirating the pre-retinal hemorrhage with one hand, Dr. Charles performs endolaser photocoagulation with the laser probe in conjunction with raising the IOP to control the bleeding. Perfluorocarbon liquid is used to stabilize the retina in the posterior pole. A retinotomy is achieved with the vitreous cutter, air/fluid exchange is performed, and the subretinal fluid is drained through the retinotomy. Perfluorocarbon liquid is then aspirated and panphotocoagulation is accomplished with the 27-gauge curved laser probe. Air/silicone oil exchange is performed through the 25-gauge sclerotomy and air is vented through one of the 27-gauge valved trocar cannulas.
This patient improved from low light perception to 20/150 best corrected visual acuity at day 5. Here we can observe the wide fundus image at day 45 postop. Her vision improved even further to 20/100
Posted: 3/16/2015
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Comments
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manmath das
9 years ago
Good surgery and a very satisfying outcome indeed. But why did you make the retinotomy as retina could have been settled without it by doing FAX through the existing break after such a nice membrane dissection. I usually avoid creating un-necessary retinotomies.
Deependra V Singh MD
10 years ago
Great Video!! 27G would further refine our dissections.. PFCL at beginning helps preventing blood sticking to macula. Also, retinotomy could have been avoided.. Nevertheless great results. Congratulations !
Fernando Arevalo
10 years ago
Beautiful surgery Martin! Congrats!!
Mounir Lezrek
10 years ago
Nice surgery congratulations. a gaz Tamponade could be better in this case. silicone oil is to be avoided in diabetic tractional detachment.
Martin Charles
10 years ago
Thanks !, Perhaps using PFCL at the beginning can be used on those cases where the macula is attached before starting
aslan aykut
10 years ago
A delicate surgery, but in the begining of the dissection i saw macular detachments because of lack of counter force in the detached retina. What do you think about injecting PFCL at the beginnig of the surgery?