Simulated Surgery: Retinal Buckling: Draining Subretinal Fluid and Injecting Air

This video demonstrates the principles behind safely draining sub-retinal fluid and then injecting air using a binocular indirect ophthalmoscope. Although it is not possible to create a retinal detachment with sub-retinal fluid using these model eyes it is still possible to practice the steps you would undertake in live surgery.

In addition to Cybersight, you can find videos featuring teaching techniques for all types of ocular surgery, using any form of simulation, in the Simulation Gallery.


>> So in this clip, we show how to drain subretinal fluid. A curved artery clip is used to visualize where the subretinal fluid is deepest, by indenting posterior to the buckle and observing with an indirect ophthalmoscope. The tip of the curved artery clip should be visible internally with pressure. And the location of the drain should be at the point where the subretinal fluid is nice and deep. We can mark on the outside of the eye, on the sclera, where the subretinal fluid is deep. And then the needle prang drain is performed with a 5-0 Ethibond needle. About a third of the needle is outside of the needle holder. And that third is then introduced through the sclera in one movement. All the time, the eye also has to be pressed on and grasped firmly with a St. Martin’s forceps, near the muscle insertion, ideally, and pressure applied to the eye, as soon as the needle comes out. And this reduces the chance of internal choroidal bleeding or subretinal bleeding. As the subretinal fluid is draining away, it can be observed with an indirect ophthalmoscope, and it’s ideal to continue pressing for three to four minutes, in order to prevent further bleeding, or any bleeding, occurring in the choroid. It should be checked before releasing the pressure, whether any bleeding has occurred. Now, we’re also showing here how a gas injection can be given into the eye, via the pars plana. And a 30-gauge needle. The tip of the needle is visualized with an indirect ophthalmoscope, and when it’s seen inside the eye, the needle should be pointing posteriorly, not towards the lens, and a single movement made to inject a single large bubble. Ideally, the injection point should be the highest point of the eye, so that the bubble will form downwards from the needle.

Last Updated: October 31, 2022

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