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Shlomit Schaal, MD, PhD
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Drs. Schaal and Sigford present in this video the latest advances in minimally invasive vitreo-retinal surgery techniques. The patient is a 30-year-old gentleman with severe vision loss due to a macula off tractional retinal detachment secondary to proliferative diabetic retinopathy. After performing a core vitrectomy, the fibrous membranes are cut using the core duty cycle setting in which the vitrector is preferentially open and the cut rate is 100 cpm. This replaces the conventional intraocular large gauge scissors otherwise needed to cut these membranes. The now-free fibrous stalk is then carefully trimmed and any adherent vitreous is removed. The same process is repeated to relieve traction from the remaining fibro-vascular membranes. The vitreous is cut with a shaving duty cycle in which the vitrector is preferentially closed and the cut rate is 5000 cpm effectively reducing further traction. Endodiathermy is then applied to the remaining fibrovascular stalks. A retinotomy is created and subretinal fluid is drained under air. Finally, supplemental panretinal endophotocoagulation is performed.
Posted: 12/04/2012
Shlomit Schaal, MD, PhD
Drs. Schaal and Sigford present in this video the latest advances in minimally invasive vitreo-retinal surgery techniques. The patient is a 30-year-old gentleman with severe vision loss due to a macula off tractional retinal detachment secondary to proliferative diabetic retinopathy. After performing a core vitrectomy, the fibrous membranes are cut using the core duty cycle setting in which the vitrector is preferentially open and the cut rate is 100 cpm. This replaces the conventional intraocular large gauge scissors otherwise needed to cut these membranes. The now-free fibrous stalk is then carefully trimmed and any adherent vitreous is removed. The same process is repeated to relieve traction from the remaining fibro-vascular membranes. The vitreous is cut with a shaving duty cycle in which the vitrector is preferentially closed and the cut rate is 5000 cpm effectively reducing further traction. Endodiathermy is then applied to the remaining fibrovascular stalks. A retinotomy is created and subretinal fluid is drained under air. Finally, supplemental panretinal endophotocoagulation is performed.
Posted: 12/04/2012
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Comments
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Stanislav Zhuk
12 years ago
Dont be happy. You definitely overcalled the complicated part - this is a very routine TRD at best. All neovascularization has regressed into thin avascular tissue that is above the retinal surface. There are a few connecting pegs between the scar and retina, that is why you can dissect and delaminate with the cutter. On a truly complicated case the scar is flatly adhered to the retina. It is much more difficult to remove that with one handed cutter and almost always requires scissors, forceps, chandelier, etc. Not to mention, complicated cases have much more vascular content and bleed when you dissect.
Shlomit Schaal
12 years ago
I respectfully disagree with you, EyeBugr. Not all cases of TRD need to be approached with scissors. The whole point of this video was to show that the vitrector may be used as scissors when the duty cycle is changed. This case was done using a chandelier and a 25G system.
Stanislav Zhuk
12 years ago
You call this "complicated" TRD?? C'mon, Kentucky! Also, why planned retinotomy for a TRD?
Shlomit Schaal
12 years ago
I am so happy our video gives you the impression that this was easy! That's great! We usually don't perform retinotomies, but in this case the tractional RD was long standing and therefore we wanted to drain the large amount of chronic subretinal fluid. Thanks for commenting!