Surgery: Vitrectomy for Retinal Detachment: Asssortment of Cases

Dr. Manish Nagpal: This video showcases surgeries for various types of retinal detachments. This is a case of a total retinal detachment, with a superior hole. Vitreous is carefully removed from the edges of the break. Subretinal fluid is debulked from the hole. After that, air-fluid exchange is carried out, which brings a bubble. And endo drainage is done through the superior break. The retina starts to flatten. Once the retina is fully flattened. Endolaser is done to the edges of the break.

This case has a superior retinal detachment with a hole seen superiorly, as well as a lattice degeneration with a hole in the inferior area. Vitrectomy is carried out, vitreous is removed from the edges of the break. And debulking of the fluid is done from the break. To identify the hyaloid, triamcinolone is injected. Triamcinolone injects the visibility of the vitreous attachment and using vacuum, we try to disengage the triamcinolone stained vitreous from the underlying retina. Gradually the vitreous gets lifted.
Once the vitreous is removed, we put perfluorocarbon to flatten the posterior pole. After that, endo drainage is carried out from the superior break, which flattens the retina. Endolaser is then carried out.

In this case, there’s a retinal detachment with a large horseshoe tear and a lasered lattice line temporally. Once again, vitreous is removed from the edges of the break. Perfluorocarbon is injected to flatten the posterior pole and push the fluid towards the break. Afterwhich, endo drainage is carried out from the region of the break. Endolaser is carried out to the edges of the tear.

This is a case of inferior retinal detachment with a single retinal break inferiorly. A total vitrectomy is carried out. After that, hyaloid is stained with triamcinolone and removed using high vacuum. The residual vitreous is then removed. Vitreous is removed from the edges of the break. Perfluorocarbon is injected to passively flatten the retina on the posterior pole. Endo drainage is done from the break, followed by endolaser.

This is a case of a total retinal detachment with a large tear superiorly, with inferior lattice and tears as well. Vitrectomy is carried out and careful removal of the vitreous is done from all around the edges of the break, as well as the rest of the retina. Perfluorocarbon is injected to flatten the posterior pole. Endo drainage is carried out from the superior tear. Once the retina flattens, endolaser is done to the edges of the breaks.

This case, there’s a total retinal detachment with a very posterior break with wrinkling seen on the retina as early PVR changes. Here, to release the contraction, we stained the eyelim with Brilliant Blue and peel it off up to the edges of the break. After that, PFCL is injected. And endolaser is done to the break. This allows the retina to flatten very well.
This case has a retinal detachment with very large, ragged temporal tears. These tears are typically caused by PVD creations. Vitreous is removed, carefully, from the edges of all the ragged edges of the breaks. Perfluorocarbon is injected to flatten the posterior pole and push the fluid towards the break. And then gradually the fluid is aspirated from the temporal breaks. After that, endolaser is done to all the edges of the breaks.

This is a case of a retinal detachment with multiple ragged, large tears superiorly. Vitreous is removed from all the aspects of the retina. Inferiorly, there is blood stained vitreous adhesion, which is also removed. Diathermy’s done to a vessel which is bridging the tears, so as to avoid any inadvertent bleeding from there. Perfluorocarbon is injected on the posterior pole, gradually up to the edges of the break.

The edges of the break, which are enfolding, are ironed out using a blunt atraumatic instrument we call the massager. That allows the retina to flatten better at the edges. You can see all the folded edges are now getting ironed back and the retina flattening well under PFCL. Endolaser is then carried out to the margins of all the breaks. Residual fluid is aspirated.
This is a case of total detachment with multiple ragged posterior tears, which developed right after the patient underwent cataract surgery. The vitreous was mixed with some vitreous hemorrhage as well. Carefully, the vitreous was removed. The retina was mobile and hence, one has to be very careful while doing that maneuver. Once the vitreous is removed, perfluorocarbon is injected to flatten the posterior pole. After that, endo drainage is done, and fluid is aspirated from the edges of the break. After that, endolaser is done to all the edges of the break as well as 360 degrees.