12/4/2023 0 Comments Surgery for torn retina![]() When subretinal fluid is to be drained, the break is rotated to the lowest position possible, the air infusion is turned on, and the air-fluid interface is drained for approximately 5 minutes. After PFCL is placed, I perform additional vitrectomy and laser.įigure 2. If the retina is totally detached, I rotate the eye nasally and instill PFCL on the nasal aspect of the disc so that it smooths out the papillomacular bundle first. I place PFCL over the attached retina with the goal of flatting the retina from the area that is attached into the detached retina, uniformly smoothing the macula out along the way. With few exceptions, PFCL is helpful (and I would say mandatory) for essentially all GRT-related detachments. This approach is by and large also useful for pseudophakic detachments however, I will occasionally perform a vitrectomy alone on a pseudophakic detachment with good results, even with a relatively small GRT. But in GRTs that are 1 quadrant in size, I do find it helpful my colleagues and I have published results from a consecutive case series that provides data on this matter. In these instances, the patient has effectively created his or her own relaxing retinectomy, so I do not find scleral buckle to be very helpful. I have seen a few eyes with GRT-associated detachments that extended 270˚ or more. Role of the Scleral Buckleįor GRT-associated detachments in phakic eyes, I tend to place an encircling band around the eye, particularly if the detachment is less than approximately 4 clock hours. Several aspects of this case are worthy of mention, and some are matters of debate. ![]() Several drops of balanced salt solution were placed on the surface of the retina and evacuated prior to instillation of 14% C 3F 8 gas. An air-fluid exchange was performed, with care taken to drain the subretinal fluid through the retinal break. ![]() Three rows of near confluent laser retinopexy were placed around the detachment and taken to the ora serrata. Perfluorocarbon liquid (PFCL) was used both to express the subretinal fluid anteriorly and to stabilize the peripheral retina to enable more complete removal of the vitreous. Intraocular triamcinolone was used to highlight the vitreous gel and to facilitate trimming of the vitreous skirt. The platform’s dual-blade cutters enable me to remove vitreous efficiently and with control even in areas with mobile retina. I use the Stellaris Elite (Bausch + Lomb) in the OR. SURGERYĪfter discussion, the patient elected to undergo surgical repair with 23-gauge vitrectomy with scleral buckling. The tear extended from approximately 12:30 o’clock to 4:00 o’clock. The posterior segment examination showed posterior vitreous separation and a macula-off rhegmatogenous retinal detachment (Figure 1). This patient had a superotemporal GRT with a macula-off detachment. On examination, he had counting fingers VA with a mild nuclear cataract.įigure 1. He had moderate myopia with no other personal or family ocular history, and he reported no ocular trauma. PRESENTATIONĪ 58-year-old phakic man presented with a 2-week history of flashes and floaters and a 4-day history of progressive vision loss in the right eye. This is for several reasons: They are relatively uncommon, there is no single best way to manage these eyes, and they can develop certain postoperative complications that can be challenging to manage and are best avoided. Retinal detachments associated with giant retinal tears (GRTs), however, are more challenging. Retinal detachment repair is a mainstay of what we do as retina surgeons, and such repairs generally have good surgical outcomes. Postoperative retinal folds in the midperiphery are not a big deal, but folds in the macula must be managed surgically. ![]() Buckling can be helpful for GRT-associated detachments, particularly if they extend 4 clock hours or less.Retinal detachments associated with giant retinal tears (GRTs) are challenging for several reasons: They are relatively uncommon, there is not one best way to manage them, and they can develop difficult postoperative complications.
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