Chronic retinal detachment (Felix Armadá-Maresca, Madrid) скачать в хорошем качестве

Chronic retinal detachment (Felix Armadá-Maresca, Madrid)

Chronic retinal detachment with anterior and posterior PVR and peripapillar subretinal strands in a napkin ring configuration Case description 72-year-old patient with total retinal detachment (RD), stiff retina, anterior PVR, posterior epiretinal membranes (ERM) and extensive peripapillar subretinal strands in a napkin ring configuration. He had been operated elsewhere 9 months before but due to RD recurrence, it was decided not to operate again. Best-corrected visual acuity (BCVA) was light perception (LP). He had a transparent cornea and was pseudophakic with 180° posterior synechia. Surgery A 4-port 23G pars plana vitrectomy (PPV) was performed (EVA vitrectomy system with valvulated microcannulae and TDC cutter). Intense retinal rigidity was observed due to massive subretinal proliferation. An access retinotomy was performed on the inferior-nasal retina to remove peripapillar subretinal membranes but complete removal was unsuccessful. A second superior-nasal retinotomy was then performed to achieve complete subretinal band removal. Afterwards, several ERM were observed and removed from the macular area. Then a 270º relaxing retinectomy (from 5 to 12 hours) was performed to deal with retinal stiffness due to intraretinal PVR. The retina was reattached with heavy liquid (PFCL) and 360º endophotocoagulation was completed under heavy liquid. Finally a direct PFCL/5000cs Silicone oil (SO) exchange (PSX) was performed. First, PFCL was injected until it flowed back through the disconnected infusion line and then SO was injected through the infusion line at a 3-bar pressure whilst PFCL was aspirated by active extrusion (stopping aspiration when IOP dropped). Follow-up The patient was instructed to remain face down for 10 days after surgery. Two months after surgery BCVA was of counting fingers, and the retina remained attached.