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PPV intrao-operative complications (14. SR dye (how to prevent it (Do not…
PPV intrao-operative complications
14. SR dye
how to prevent it
Do not inject under air
Do not create a jet
Use brilliant blue
How to solve it
flute to wash out
create a retinotomy
worse case scenario
closed hole but worse vision
15. Iatrogenic retinal tear
A. Due to vitreous traction
how to prevent it:
bullous RD, reduce the height (prevent Vitreous incarcetation
reduce IOP,
avoid port leakage
incarcerated vitreous: PFCL, FAX.
break caused by PVD always inferiorly: prevent it by cutting once PVD is induced
late tear occurs from the contraction of vitreous skirts + extensive laser or cryo
B. Due to retina trauma
how to prevent it
re-grab for ERM
watch for large instrument entering eye
During diabetic
Do not rip the peg
if hole made, remove all traction
Avoid bleding
During PVR
peel centrafugally rather than centripedal
avoid pinching retina
look at the oblique, should have translucent zone if ERM is grabbed
watch for surround retina for stress tissue
from cryonecrosis
Over cryo = haem + white RPE
The missing break
How to solve it
Look under vitreous skirts
shaving up to vitreous base
subretinal dye
If no break is found
encircling band or buckle the suspecious area
360 degree retinopexy 2 lines @ VB then radial
Retinal slippage
risks
large GRT>180 (cord length > arc length)
aquous edge difficult to see
rotating eye doesn't help
encircling band cause radial fold
How to prevent it
Direct PFCL/Oil exchange
flute needle pass through oil and PFCL in order to mix both
Overfill method then PFCL/Air or Oil exchange
overfill completely until no BSS, then 3 way tab to infuse air or SO
how to solve it
redetach the retina with BSS
SO in situ, be careful aspirate oil out, watch retina
mild, stroke with soft tip needle
Lens touch
Deep set eye + those with cataract