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Shlomit Schaal, MD, PhD
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Drs. Schaal and Sigford present the repair of a total bullous rhegmatogenous retinal detachment using 25-gauge pars plana vitrectomy. A 41-year-old gentleman presented with severe vision loss due to a macula off retinal detachment. The bullous nature of the detachment could be seen prior to core vitrectomy. Perfluorocarbon heavy liquid was used to flatten the detached retina. After a partial fill, the infusion was stopped to drain subretinal fluid. The flap of the horseshoe tear was removed and subretinal fluid was drained through the original break. Once this extra volume was removed, more perfluorocarbon was added. An initial ring of endophotocoagulation was applied to the peripheral retina. The margins of the break were marked with endodiathermy and an air/fluid exchange was performed over the perfluorocarbon bubble. Additional subretinal fluid was drained and the perfluorocarbon bubble was removed. Endophotocoagulation was again applied in the area of the retinal break and the air/fluid exchange was completed. At the end of the surgery, the patient was left with 25% SF6 gas.
Posted: 11/15/2012
Shlomit Schaal, MD, PhD
Drs. Schaal and Sigford present the repair of a total bullous rhegmatogenous retinal detachment using 25-gauge pars plana vitrectomy. A 41-year-old gentleman presented with severe vision loss due to a macula off retinal detachment. The bullous nature of the detachment could be seen prior to core vitrectomy. Perfluorocarbon heavy liquid was used to flatten the detached retina. After a partial fill, the infusion was stopped to drain subretinal fluid. The flap of the horseshoe tear was removed and subretinal fluid was drained through the original break. Once this extra volume was removed, more perfluorocarbon was added. An initial ring of endophotocoagulation was applied to the peripheral retina. The margins of the break were marked with endodiathermy and an air/fluid exchange was performed over the perfluorocarbon bubble. Additional subretinal fluid was drained and the perfluorocarbon bubble was removed. Endophotocoagulation was again applied in the area of the retinal break and the air/fluid exchange was completed. At the end of the surgery, the patient was left with 25% SF6 gas.
Posted: 11/15/2012
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SHALABH SINHA
12 years ago
This was failed buckle case. I see no reason for a "mid peripheral" 360 degrees laser. The buckle would effectively tamponade any peripheral break should it occur, or better still "check" for the break rather than blind laser. More damage, more CME, less vision.
SHALABH SINHA
12 years ago
This was failed buckle case. I see no reason for a "mid peripheral" 360 degrees laser. The buckle would effectively tamponade any peripheral break should it occur, or better still "check" for the break rather than blind laser. More damage, more CME, less vision.
Shlomit Schaal
12 years ago
Please note that this was NOT a failed buckle case, it was a case of primary vitrectomy for bullous RD, macula off, near total detachment. The video under air gives you the illusion of a buckle. The vision after surgery is 20/20, and no CME is present.
Shlomit Schaal
12 years ago
Another important point: the laser is done at the far periphery, not at mid-periphery!
Shlomit Schaal
12 years ago
Thank you for your comment. I usually perform 360 degree laser retinopexy at the end of every retinal detachment case to lower the risk of re-detachment by an un-noticed tear. This is most common in pseudophakic patients. Please see this reference: Retina. 2007 Jul-Aug;27(6):744-9. Prophylactic intraoperative 360 degrees laser retinopexy for prevention of retinal detachment. Koh HJ, Cheng L, Kosobucki B, Freeman WR.
Diego Sanchez Chicharro
12 years ago
Thank you for this great video. Should there was only one Sup-Temp break, why did you perform a 360 degrees laser barrier? Thank you