Retinal Detachment with PVR and Hypotony (Parra, Spain) скачать в хорошем качестве

Retinal Detachment with PVR and Hypotony (Parra, Spain)

Juan Manuel Cubero Parra, Córdoba (Spain) Case description 72 y/o woman with recurrent retinal detachment (RD) under silicone oil (SO) in her right eye. She had been operated of pars plana vitrectomy (PPV) because of RD and macular hole three times. The right eye was pseudophakic and it was diagnosed of atrophic age-related macular degeneration (AMD) 6 months ago. Snellen's best-corrected visual acuity (VA) was light perception (LP) without projection. Slit-lamp examination revealed anterior chamber cells ++, and posterior-superior synechia with pigment on intraocular lens (IOL) and inferior iridectomy. IOP was 4 mmHg. Fundus examination showed RD with epiretinal membranes (ERMs) on the macula and temporal quadrant with severe inferior retinal stiffness. The left eye was amaurotic because of a RD 40 years ago. Surgery description. 23G PPV with an accessory light infusion was conducted under general anesthesia. First, SO was removed and macular ERMs were peeled bimanually with two forceps. One forceps was used to grasp the ERM and the other one to dissect it bluntly from the underlying retina. ERMs with extreme retinal adherence were segmented using forceps and scissors. Posterior hyaloid (PH) remnants were found on the upper retina and they were detached up to the posterior vitreous base (VB) by pulling with two forceps to avoid retinal tearing. The scarred PH remnants at VB were dissected bluntly with two forceps in order to relieve circumferential traction. Then, heavy liquid (PFCL) was used to reattach the retina but inferior retinal stiffness prevented it. Thus, an inferior retinectomy was performed to relax anterior-posterior traction. Diathermy was applied to the cutting area and the vitreous cutter was used to remove the stiff anterior retina and anterior vitreous remnants to avoid any traction at ciliary body and hypotony. A subretinal clot was moved to the retinectomy edge sweeping it smoothly with a silicone tip cannula, and extracted with the vitreous cutter. Subretinal membranes at the retinectomy edge were removed directly with forceps. Finally, the vitreous cavity was filled with PFCL to reattach the retina and laser photocoagulation was applied to the retinectomy border. 5000cs SO was left as tamponade using a PFCL/Air exchange (FAX) followed by an Air/Silicone Oil Exchange (ASX). Follow-up The patient was instructed to stay on prone position during the day, and on left lateral decubitus at night, for a week. After a 4-month follow-up, the retina was attached under SO. Best-corrected VA was counting fingers (CF) due to macular atrophy but the patient was able to recognize colors and orient herself in an unknown room without help.