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(3D) Vitrectomy for the Management of a Giant Retinal Tear скачать в хорошем качестве

(3D) Vitrectomy for the Management of a Giant Retinal Tear 9 месяцев назад

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(3D) Vitrectomy for the Management of a Giant Retinal Tear
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(3D) Vitrectomy for the Management of a Giant Retinal Tear

Surgical Description: Title: Vitrectomy for the Management of a Giant Retinal Tear. This is a 55-year-old pseudophakic patient undergoing a 23-gauge pars plana vitrectomy. A core and peripheral vitrectomy is initiated, carefully separating vitreous adhesions from the retina. Mild vitreous hemorrhage and posterior vitreous detachment are observed. Special attention is given to avoid traction on the highly mobile retinal periphery Despite the macula being off, an early approach is essential to avoid Proliferative Vitreoretinopathy (PVR). PVR could be a late complication of GRT and a leading cause of surgical failure. Increased access to the retinal pigment epithelium (RPE) allows more cells and pigment to escape into the vitreous cavity and retinal surface, raising the risk of PVR As evident, the vitreous is highly condensed at the base, with the capsular opacity concealing a portion of the inserted cutter at the entry site. The image shows the retina folded over the macular area. The tear's edges are very close to the peripheral retina vessels, requiring close monitoring to avoid contact and potential bleeding. With a large tear like that, the anterior insertion of the retina loses peripheral support, causing the retina to fold back on itself. Additionally, the retina tends to roll due to the lack of vitreous attachment. Perfluorocarbon liquid (PFC) is injected into the macular area to flatten the retina. It comes in multiple bubbles, so injection should be slow. A safer approach is to use a 10 cc syringe for the injection, ensuring the stream does not forcefully impact and harm the retina. Endolaser treatment is the next step, targeting the retina lining directly. Endolaser treatment is performed using perfluorocarbon liquid, which provides excellent visualization. A wide-angle vitrectomy viewing system provides excellent peripheral visualization. Additional PFC is injected to cover the retina up to the extreme periphery. A 23Ga cannula is used to remove PFC and replace it with silicone oil, performing a direct exchange. The action should be performed slowly to avoid dislocating the retina, ensuring it remains in the correct position and preventing any rotation. The exchange begins at the very periphery, preventing perfluorocarbon from entering the subretinal space. Silicone oil has been proven to be more effective for early visual rehabilitation and is safer to exchange with perfluorocarbons. Although tiny bubbles that didn’t coalesce upon injection need to be dealt with, patience is crucial to remove them all. Using a macula lens ensures none are missed. Maintaining a slow pace is essential to avoid retinal dislocation. Finally, the retina must be thoroughly examined. By inspecting the retinal periphery and through the air bubble in the vitreous cavity, an effective laser can be observed, along with an attached macula and no retinal slippage, achieving the desired intraoperative result. On postoperative day seven, the retina is fully attached. There are some peripheral hemorrhages, likely from leaking retinal vessels. The macula is unaffected and looks pretty good. Scleral sutures were put at the end. I appreciate your attention. Thanks.

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