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Tips for retinal detachment surgery (Complex RD cases (Tips:…
Tips for retinal detachment surgery
Complex RD cases
Schisis RD
Retinotomy @ Full thickness RD side
Silicone oil tamponade
laser the outer leave
360 encircling band
Overdo it!
GRT
Gas for minimal SRF
Cryo is sufficient
PVR
HL up to tear, then drain SRF under air, then fill HL all the way up, then A-F-X.then check if retina is flat, if it's not then retinectomy
Peel as much as possible
Don't cut if retina flat
You dont need to do everything in complex case, no need laser, come back and do it.
RD with MH
HL to cover hole
2.Dual blue and shift the HL around
peel without HL.
Drain from hole, then patch it with flap
Aphakic or Ac IOL
Miocol b4 FAX
One big air bubble in AC
10.0 prolene to make a net
If pupil is small then no need the silicone oil net
Tips: Suprachoroidal Haem
360 peritomy:
equator = AL/2 from limbus
radial cut: 8mm from limbus
cut around 2-4mm radial
then use cycodialysis spatula or iris reposition spatula
otherwise, consider drain 10-14 days,
can drain with tPA, 100 microgram 30 minutes before
PVD
Always use Triamcinolone
inject toward the anterior retina
check for schisis
unable to induced past equator
consider 360 band
pull until you see white line
trim as much as possible
Use push retina techniques
Unable to induce PVD
use barbed needle
use flexi-loop to get the thin vitreous from fovea
Drainage retinotomy
PVR unlikely
Posterior outside arcade
Drain all SRF @ one go.
Use of HL
Do not tilt on draining SRF
Jet stream= draining air
wrong concept:
The correct one is to tilt the eye and drain from opposite direction as heavy liquid press the fluid out and it's lighter than HL
reduce air infusion during injection.
use assitant to extrac the heavy liquid instead
Efficient vitrectomy
phakic or pseudo
chandelier
increase light to 80%
12 oclock, untap, bend 90 degree
Insert it superiorly
Ibox not close to cornea to disturb the chandelier
self indent, reduce IOP
systematic:
indent too much causes cornea edema
core vity
peripheral
Indent and shave
cornea crap after multiple indent
indent one round only
need to see skirt and trim
Use cotton bud to measure the distant.
inject antibiotics before taking out the infusion port
Intra Op issues
Unable to find break
under the vitreous skirt
induce PVD up to ora
use subretina blue
360 laser 2 rolls from the PVD edge
Macular fold
lie with op side down for 1 hour, then posture after that
causes of failure
silicone oil fill
How to avoid overfill
refill AC with BSS, shallow AC cause PS
check IOP with tonopen @ the end
put light pipe back in to see if there's trapped air
