This video demonstrates the surgery for a simple vitreous hemorrhage. The hemorrhage was aspirated using a cutter with high cutting rate. The hyaloid was separated from the hemorrhage and was removed using the cutter. The hemorrhage was cleared starting from the center and moving towards the periphery. A laser was done to seal a small blood leak and air fluid exchange was done.
Surgeon: Dr. Manish Nagpal, Retina Foundation & Eye Research Centre, Ahmedabad, India
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Dr. Manish Nagpal: This is a case of a vitreous hemorrhage. The 25 gauge par spreader cannulas are placed. The inner temporal cannula is placed with the infusion, and the cutter and the light pipe ports are also placed after that. Once the cannulas are in place, the viewing lens is put on the corneal surface. And a view of the fundus is established. You can see a vitreous hemorrhage in the central part of the fundus view. The cutter is now in the central part of the vitreous cavity and is clearing the vitreous hemorrhage. At this stage, we use a high cutting rate. And this cutter is in the core area. And the vacuum is kept at a preset of the highest available, 650.
And you can see that I’m trying to create a hyaloidal detachment. The hyaloid has got interspersed with the vitreous hemorrhage on its and I’m slowly trying to separate it from the vitreous surface and then remove it using the cutter. We start from the central area and then slowly clear all the peripheral area of the hemorrhage.
Slowly the fundus starts to clear up and you can get a good view of the disk and the macula. The residual vitreous is removed. And now the blood lying over the retinal surface is aspirated.
There’s a small ooze which is seen supertemporal to the macula, which is now sealed with a laser. Now air fluid exchange is being done. I usually prefer to leave the vitreous cavity in the air at the end of surgery. It helps prevent any hypotony post operatively. So, the fluid is being aspirated and the air comes in and replaces it. And we keep the cutter over the disk and slowly aspirate until the end.
There is still some residual which could be seen at the end of a fluid exchange with the supra nasal area where we now remove using the cutter.
Once again, residual fluid is aspirated from over the disk.
January 29, 2018