Chronic retinal detachment with PVR CA1. (Francisco J. Lara Medina, Spain) скачать в хорошем качестве

Chronic retinal detachment with PVR CA1. (Francisco J. Lara Medina, Spain)

Case Description 68yo male affected by a chronic pseudophakic retinal detachment (RD) of 6 months of evolution, vitreous haze and localized upper anterior PVR CA1. Surgical Procedure Surgery started by placing a 2.5mm scleral band 12 mm from the limbus. The band was fixed with scleral tunnels, avoiding the need for sutures and achieving a better integration with ocular surface. Afterwards, 23G pars plana vitrectomy (PPV) was performed although vitreous turbidity hindered detached retina visualization. Once central vitreous was removed, superior vitreous base (VB) scarring and a retinal tear at V hours were observed. Posterior hyaloid (PH) remained adherent to the upper peripheral retina. Vitreous cutter without cutting was used to detach PH using anterior-posterior movements parallel to the retina. This maneuver should always be performed stabilizing detached retina with external scleral indentation. Indentation can be performed by an experienced assistant or, preferably by the surgeon (using an auxiliary chandelier light). Once PH was lifted, the vitreous cutter was used to segment scarred PH at VB. When the vitreous cutter could not dissect PH anymore, 23G ILM forceps were used instead. Anterior membranes and scarred PH at VB were completely dissected and removed bimanually with forceps and vitreous cutter. Forceps were used to lift the membranes and vitreous cutter to dissect them bluntly by backpressure movements. When a cleavage plane was obtained, PH traction was cut with the vitrectomy probe. After dealing with localized anterior PVR, heavy liquid (PFCL) was injected to perform the reattachment test and remove thick subretinal fluid (SRF) through a pre-existing retinal tear. A pocket of persistent SRF in the nasal retina was removed with gentle massage towards the retinal tear by scleral indentation. Then, complete peripheral vitrectomy with indentation was performed. Finally, the eye was filled with PFCL and laser photocoagulation was done on rhegmatogenous retinal lesions, especially on the retinal area where proliferations were removed. Fluid-PFCL/Air exchange (FAX) was performed followed by 360º laser-cerclage. C3F8 12% was left as tamponade. Follow-up Retinal was completely attached without tamponade