In this surgical video, Dr. Riemann demonstrates a suprachoroidal chandelier buckle technique using a heads-up display in a 54-year-old female, who presented with a retinal detachment.
Surgeon: Dr. Chris Reimann, Cincinnati Eye Institute, USA
Today I’d like to show my technique for a heads up suprachoroidal chandelier buckle. This is the first one of these I’ve done. This is a 56-year-old woman who presents with a mac-on retinal detachment. Pretty vanilla, pretty boring. Except for: She had very high myopia and a peripheral temporal staphyloma, and severe Meniere’s disease, making it impossible for her to position. She also thought that she needed to fly. So the challenge in this case is: How do we fix this retinal detachment without a bubble and without a buckle? It kind of makes you want to scream. Fortunately, Dr. El Rayes and Dr. Oshima showed us the suprachoroidal scleral buckle technique in 2013. To my knowledge, this is the first time heads up suprachoroidal buckling surgery has been presented. We open the conjunctiva and Tenon’s capsule, and promptly find the temporal staphyloma. This is why an external buckle would have been problematic. We hook the temporal, inferior, and superior muscles and place a chandelier. With scleral depression, we find and mark the retinal break. With a marker depressor, sterile marking pen, and then a low temp cautery. We also mark the superiormost extent of the retinal detachment and the inferiormost extent of the retinal detachment. We place cryo around the causative retinal breaks. And then make our sclerotomy away from the retinal break. We see here that with a crescent blade, it doesn’t take much to cut through this very thin sclera. And as we extend the sclerotomy with scissors, we inadvertently penetrate the choroid. Fortunately, we needed an external drain here anyway, and will be opportunists about accepting this. We open the sclerotomy just a little bit more, to make room for the Med-1 olive tip suprachoroidal cannula. We place this under the retinal break, in the suprachoroidal space. And inject viscoelastic. And we see how thin and flexible the sclera is. It balloons out, as a function of the injected viscoelastic. I’m using Healon GV here. When we look with the Merlin Wide Angle viewing system and the chandelier without scleral depression, we see a beautiful suprachoroidal buckle, excellent cryo, and a closed retinal break. We remove the chandelier port, close the conjunctiva and Tenon’s capsule, and on postoperative day one, the break is closed. There’s a small amount of shallow subretinal fluid. This has resorbed by postoperative week 1. At weeks 3 and 6, we see the choroidal elevation resolving. And by month 3, the retina and choroid are both totally flat.
September 28, 2019