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Richard Lin MD, Seenu Hariprasad MD
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23g Repair of 180 degree Giant Retinal Tear by Dr. Richard Lin and Dr.Seenu Hariprasad
Posted: 2/25/2008
Richard Lin MD, Seenu Hariprasad MD
23g Repair of 180 degree Giant Retinal Tear by Dr. Richard Lin and Dr.Seenu Hariprasad
Posted: 2/25/2008
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Rizwan Cheema
16 years ago
Great surgery. I liked your step of diathermy on the GRT edge to keep visulaization. Few comments 1. Post hyaloid seperation: How do you make sure in such young patients that no residual vitreous is left 2. Why not do PFCL/Oil exchange to prevent slippage, and I suprised it did not slip during this procedure 3. Do you think 360 buckle is needed as some studies suggest it may be beneficial.
Seenu Hariprasad
16 years ago
Hi Drs. Rac, Fong, Mayfield, and Bastion:
Mohamed Ismail
16 years ago
good
Kenneth Fong
16 years ago
Great video. What are your thoughts about leaving the perfluoron / heavy liquid in the eye for 5 days with the pt lying on their back during that time before removing it and replacing with gas? I see you used silicone oil here - that would still require a second procedure later on plus the risk of cataract in a youngish patient. I find fluid-air exchange in these cases to be the most challenging part and the risk of retinal slippage is always there, leaving heavy liquid in for a few days seems to make life easier for me and the patient
Nicholas Mayfield
16 years ago
Dr. Harisaprad,
Bugimbi Chibuga
16 years ago
Good video. I am still new in VRS, I am used to 20g instrumentation. My center has only 20g
Mae-Lynn Bastion
16 years ago
Hi dr. Please may I know your vitrectomy settings eg Vacuum, cut rate etc during the main parts of the surgery? Thank you for your excellent video and teaching comments.
SHALABH SINHA
16 years ago
Dr. Hariprasad, you made no attemt to identify if a PVD was present or not. I think it was imperitive to do so using triamcinolone crystals to assist you. Also I think positioning the laser filter correctly in the microscope gets rid of the green flashes we get to see each time you laser. I hope your assistant was protected.
Seenu Hariprasad
16 years ago
Hi Dr. Shalabh: Yes, this patient did have a PVD present, however, your point is very well taken that diluted Kenalog or Triesence can be used to highlight vitreous and other membranes. Yes, my assistant and I use laser filters, however, we don't use a laser filter for the video camera port.
Seenu Hariprasad
16 years ago
Hi Bob: Excellent comment. Bubbles at the PFO-BSS interface can be very annoying and is a very real problem. There are two techniques that I use to help in this situation. 1) Reduce infusion IOP to minimum necessary. 2) Use minimum PFO necessary to do endolaser. Try these techniques and let me know if they are useful!
Bob Bourke
16 years ago
Excellent 23g surgery for GRT. Any pearls to maintain good visualisation of the giant retinal tear edge during endolaser to avoid bubbles occurring from infusion fluid disturbing the heavy liquid - BSS interface at the peripheral giant retinal tear edge.Regards Bob
Seenu Hariprasad
16 years ago
Hi Yepez: Thanks. Not sure if you can send the video. Obviously, you could share the link to the video.
juan yepez
16 years ago
Very nice video. How Can I send a video?
Seenu Hariprasad
17 years ago
Hi wamidh simawi: I have a very good friend and colleague in the US who routinely uses the Chandaliar light to facilitate bi-manual vitrectomy surgery. I would love to see a video of your technique when you post it on this website! Sounds very interesting.
wamidh simawi
17 years ago
Elegant surgery !
Seenu Hariprasad
17 years ago
Hi M. Sanchez: Very good comments suggesting an alternate method to inject silicone oil. I have also used the Landers visualization system in the past and it is a nice portable system. However, I use the BIOM routinely.
manuel sanchez-morrill
17 years ago
I do this procedure with ga 25 in a similar way, the only thing is that at the end i do a gate ga 20 for endophotocuagulation and the aplication of silicon oil
Chuck Madsen
17 years ago
The 23ga Alcon Tapered Tip endodiathermy is a 20ga shaft and is tapered to a 23ga tip. The companies that make the 25ga and 23ga endodiathermy are Medtronic (25ga) and Kirwan (23& 25ga)
Seenu Hariprasad
17 years ago
I am a huge fan of BIOM. Great visualization of the periphery and great visualization under various conditions- BSS, air, SO, PFO, etc...
slawomir cisiecki
17 years ago
Excellent comments. What type of viewing system did you use?. it was a phakic eye - so no problem with visualisation under air?
Seenu Hariprasad
17 years ago
Excellent comments. When I need intraocular diathermy in 23g cases, I use a 25g diathermy probe.
Wener Cella
17 years ago
What type of endodiathermy probe did you use? Alcon 23G endodiathermy probe doesn't pass through the trocater.
Emiliano Fulda Graue
17 years ago
25Ga Alcon endodiathermy, that work for me as the endodiathermy thats 23Ga is only 23Ga the tip.
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