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Every week we share an interesting case in Medical or Surgical Retina. keep updated.
Week 41.2024
🔴🎥 Video: Post-Pneumatic Retinopexy Retinal Detachment with Proliferative Vitreoretinopathy - Macula Spared Vitrectomy
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Learn each step of the surgery with the following surgical description:
This is Inverted vitrectomy
Post-Pneumatic Retinopexy
Retinal Detachment
with
Proliferative Vitreoretinopathy
Macula Spared Vitrectomy
Initially, the patient underwent Pneumatic Retinopexy for a superior retinal detachment, and the retina remained attached for several days. OCT and retina images show pre- and post-op laser results. Despite barrier laser, gas injections, and proper head positioning until the gas bubble dissipated, the retina detached again after three attempts, yet the macula always remained spared. This is patient’s right eye. The left eye was operated elsewhere, has silicon oil but a poor outcome, since the macula was detached.
A 23Ga pars plana vitrectomy was performed carefully, a complete one, from core to periphery, while avoiding contact with the lens equator. Precise, synchronized movements were employed by tilting the eye and instruments simultaneously.
Perfluorocarbon liquid was injected to protect the macula, preventing detachment from extending into the macular area. Its weight and surface tension mechanically stabilize the retina, preventing further detachment.
The vitreous base was carefully approached from superior to inferior, removing all potential vitreous fiber attachments. This procedure enhanced the mobility and flexibility of the retina.
To address superior PVR (Proliferative Vitreoretinopathy), a retinotomy was performed to locally relieve retinal traction. This aimed to counteract gravitational force towards the superior temporal arcade, preventing further advancement. The cutter was oriented toward the retina, taking care to avoid peripheral vessels, ensuring a clear media.
A nasal inferior relaxing retinotomy was required to prevent further progression of inferior retinal detachment and PVR.
Always a plus to have a crystal-clear view during the procedure! It makes all the difference for precision.
Additional perfluorocarbon liquid is required to access the extreme periphery.
By further flattening the retina, an initial internal laser pass is applied, preparing the area for additional peripheral laser spots later.
A 360-degree barrier laser was applied.
Next, an inferior relief retinotomy is performed, creating a small hole. Subretinal fluid is released, further flattening the retina.
See how far the first roll of laser extends? This makes further vitreous base work easier, paving the way for subsequent procedures.
A bit more PFC is injected to provide a thorough view from the center to the far periphery. New laser spots are then applied anterior to the first line of laser to complete the attachment.
Tiny air bubbles may form during laser coagulation, as the laser can vaporize small amounts of fluid. These bubbles are harmless and can be removed with additional vitrectomy afterward.
An air-fluid exchange is initiated to remove peripheral fluid from the infusion line and perfluorocarbon liquid from vitreous cavity. It's crucial to start with the retina periphery to prevent fluid from entering the retinotomies and causing further detachment.
A gentle and slow AFX is initiated to remove PFC until the last droplet is eliminated. Since the infusion liquid was removed earlier, there's no risk of overlooking any fluid, making perfluorocarbon removal easier due to its constant visibility. This also underscores the importance of avoiding contact with the lens throughout the procedure.
Retinal "memory" from PVR can initially prevent immediate flattening, but this typically resolves, leading to full attachment in the postoperative days. It is crucial to remove any fluid from the far periphery, but always be mindful not to touch the lens.
Time for more laser inferiorly, where the retinotomy was created, since it was placed very peripherally, and no fluid inside is desirable. Afterwards, another superior laser barrier is applied. Retina is pretty good looking now.
SF6 gas is injected through the infusion line following the air-fluid exchange. While scleral sutures are not always used, they were applied in this case to protect the patient’s best eye and vision. Additional diluted gas was introduced through the sclerotome to prevent any hypotony. The gas concentration was slightly expansible, and the patient was instructed to maintain a face-down position. I really appreciate your attention.
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Week 40.2024
Popper's Maculopathy and Differentials:
🔴🗞News.Retinawesome | Knowledge Review | Week 40.2024 | Poppers | Source (paper El País - Spain): https://elpais.com/america/sociedad/ | Article 1: Adverse ophthalmic reaction in poppers users: case series of 'poppers maculopathy’: https://pubmed.ncbi.nlm.nih.gov/23079752/ | Article 2: UAIM: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9247484/ | Article 3: https://fluorescene.odcommunity.com/interesting-retinal-cases-7/ Visit our WebPage at: http://www.retinawesome.online
Daniel, a popper consumer: "for a sudden event that lasted 10 seconts, I almost got blind of one eye"
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