This video demonstrates the surgery in a patient with retinal detachment with a horse shoe tear in superotemporal quadrant. The vitreous was removed from the edges of the tear and also all the peripheral vitreous was removed. An air fluid exchange was done after all the vitreous was removed. Endo drainage was done form the superior part of the tear. Endolaser was performed on the margins of the tear in two to three rows.
Surgeon: Dr. Manish Nagpal, Retina Foundation & Eye Research Centre, Ahmedabad, India
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Dr. Manish Nagpal: This is a case of a retinal detachment with a horseshoe tear in the supratemporal cordon. A vitrectomy is being done. The vitreous is carefully removed from the edges of the tear. When doing this maneuver, one has to be careful that one does not iatrogenically create a break in the retinal surface.
The peripheral which is removed from all the 360 degrees. You can see the extent of the detachment in the superior region. And alongside the tear there is a lot of fluid with some folds of the retinal surface.
Once again, the cutter is moved to check for any residue which is around the margins of the tear. We need to make sure that the retina is totally free of vitreous from there so as not to lead to proliferative retinopathy in the post operative period.
Once the vitreous is removed, then air-fluid exchange can be done. You can see the bubble of air slowly coming into the vitreous cavity. And then the cutter port is taken down to the disk so that a full air-fluid exchange can be done. The air replaces the fluid at this stage. While doing so, you can see the bullous of the retina coming up right towards the disk. This means that the retina is free from all traction. The residual vitreous is removed. As you can see, in the peripheral part. Once the air is inside, you can see a little more wider in the extreme periphery and the glistening reflects of the vitreous is visible. Which is removed. Residual over the disk is aspirated.
And then endo drainage is done from the superior part of the tear, which is there. The cutter is slowly insinuated under the margin of the tear and with gentle vacuum the fluid is aspirated. Slowly the bullous will reduce in size and flatten out.
We can see the fluid aspirating through the tear. The bullous are flattened out. The margins of the tear are being aspirated for any residual fluid. Residual fluid is aspirated. Some residual vitreous in the extreme periphery is removed. The tear is indented from outside to make sure that it is totally free from any residual vitreous. After this, endolaser is done to the margins of the break in two to three rows. Once again, any residual fluid is aspirated from the edges of the break.
The retina is completely flat at this stage.
January 29, 2018