Minimally invasive vitrectomy for Phakic Retinal Detachment - How to avoid lens touch скачать в хорошем качестве

Minimally invasive vitrectomy for Phakic Retinal Detachment - How to avoid lens touch

Comments from the surgery: This is Inverted VitrectomyTitle: Minimally invasive vitrectomy for Phakic Retinal Detachment - How to avoid lens touch: The patient is phakic and has a pretty clear lens. An inferotemporal sclerotomy is placed 1st, followed by a superotemporal and superonasal sclerotomy, as well.  A 23Ga pars plana vitrectomy was carried out. Core vitrectomy was started right away. The image was not reinverted. To approach the far temporal periphery, notice that the cutter opening is facing the very peripheral vitreous, and to reach that far periphery, the eye is turned towards the temporal direction, the same moment the cutter goes towards the temporal side - the movements ought to be simultaneous, as not to touch the lens at the posterior capsule, with the shaft of the cutter nor the light pipe - both instruments have their tips pointing the retina, making a right 90 degrees angle with each other. When moving inferiorly, as it was stated, the referred tips go down simultaneously with the movement of the eye inferiorly. 5.1 Now going temporal and superiorly, the vitreous base is removed, with those synchronic movements mentioned, with cutter and light pipe aligned, the eye always mobile, controlled by a kind of steering wheel movement with both hands. That works perfectly.At the very nasal periphery there was a Retinal Detachment, split in two parts, separated by a fixed fold between the two bullous retinal elevations. A superior-nasal break was at the upper part of the detachment and inferiorly, a retinotomy was created as to link the two breaks so as to flatten the retina properly. 6.1 The cutter had to be placed facing the periphery, the opening towards the temporal side, and the mobile retina approaches it where there are no vessels, so that no bleeding occurs and the retinotomy created is a small and regular one.The lens was kept clear at all times in this way making the procedure very visualizable and less time consuming because the retina could be seen from center to periphery, without losing 3D and depth perception. To attach retina at the very periphery, perfluorocarbon liquid was poured. Often times, it could go with many bubbles but they soon coalesce into one larger one.Intraocular pressure should be set to a minimum, reaching around 22mmHg, to allow PFC in with not much resistanceEndolaser was now an easy step, of course taking good care to do it - the advantages now are to have PFC weighing in on the peripheral retina, attaching it and making it easier to have a good uptake - avoiding touching the lens at the very periphery, again by tilting the eye and at the same time moving the shaft towards the peripheral retina, standing on the same position and creating an arcuate shape of the laser, as a barrier, involving the retinotomy created, almost not visible as they are pretty flat.An AFX - Air fluid exchange - was the next step of the procedure, and of course it has to be started there, where the retinotomy is, so by keeping the eye tilted saline solution is removed first and PFC right next, in order to avoid any liquid go through the holes and retinotomy towards Subretinal space, getting it really dry until positions are converted with simultaneous movement of the eye to the anatomic position, where the optic nerve is best visualized and the last PFC droplet removed. Retina is attached and the lens pretty clear. Because gas is to be injected now, a close to non expansible concentration, but with a desirable large arc of contact and good volume for good buoyancy action, patient is advised to abide to head down position. Thank you very much for your attention.