Retinal detachment under silicone oil with PVR (Koch, France) скачать в хорошем качестве

Retinal detachment under silicone oil with PVR (Koch, France)

Dr Philippe Koch. Orsay-Paris South University (France) Case Description This is the case of 49 years old man who presented 5 months ago with an history of ocular trauma and a decreased visual acuity (VA) since 10 days. Examination showed a full retinal detachment (RD) of the left eye due to a giant retinal tear (GRT) extending from 7 to 11 o’clock associated to multiple risk factors of PVR (massive vitreous bleeding, hypotony, choroidal detachment, and tobacco dust). The patient was operated with a 23G pars plana vitrectomy (PPV), a laser treatment around the GRT and silicone oil (SO) injection at the end of surgery to reposition the retina. Even with an appropriate tamponade using SO, the patient developed one month after his first surgery a massive inferior PVR CA3, contracting the retina from 4 to 7 o’clock and opening again the initial tear at 7 o’clock. He was thus immediately re-operated to stabilize the situation. Surgical Procedure -Noticeable instruments: 23G Diamond duster, 23G ILM pick from synergetics, and 23G ILM forceps from Dorc. The procedure started with a SO removal through a 2-port 23G PPV and an active extrusion. A wide-angle viewing system allowed to visualize the PVR areas contracting the retina inferiorly, as confirmed by a trypan blue staining. Complete vitreous shaving was checked using a vitrectome probe and a diamond-duster and 23G forceps were then used to try to detach anterior epiretinal membranes (ERMs). However, ERM attachment was too strong and these attempts were inefficient using these conventional methods. As a contrary, the use of an ILM-pick allowed a smooth dissection and detachment of this ERM until being peeled using forceps. A second set of ERM dissections was then performed to show how this pick can be helpful to weaken and dissect the anterior PVR prior to remove it from the retina using forceps. As observed at the end of surgery, the inferior retina was mobile again and laser was applied inferiorly from 3 to 8 o’clock under heavy liquid (PFCL) to secure the retina prior to perform a direct PFCL/Heavy SO (Densiron) exchange (PSX). Follow-up (Fig 3) 8 weeks later, a new surgery was performed to remove Densiron and the retina remained attached. Another two months after surgery, the patient is recovering with a flat retina and a best-corrected VA (BCVA) of 20/200. In conclusion, in some tricky situations, ILM pick is becoming a powerful instrument to weaken and dissect the PVR from the retina and then detach it with forceps. By slightly moving it laterally, this instrument achieves to weaken the PVR. However, in some situations, PVR cannot be dissected even using this method and a peripheral retinectomy is preferred, particularly in cases were retinal breaks occur while peeling the PVR.