Managing PVR Retinal Detachment with ILM Peel under Liquid Perfluorocarbon | by Hudson Nakamura

Managing PVR Retinal Detachment with ILM Peel under Liquid Perfluorocarbon | by Hudson Nakamura

Surgery Description:

This is inverted Vitrectomy

Managing PVR Retinal Detachment with ILM Peel under Liquid Perfluorocarbon

The Patient is Phakic and had a pretty clear lens

A left superior retinal detachment was approached

The retina was shortened secondary to PVR (Proliferative Vitreoretinopathy) as you see here. Even though we tried to avoid peripheral vessels, some might have been caught generating this mild vitreous hemorrhage, just halted with some IOP elevation. 

Because a bit more of relief retinotomy was planned endocautery was used so as to make it feasible to perform

Retina was then unfolded and a subretinal vitrectomy was carried out aiming to get rid of any loose RPE cells that could possibly contribute to any additional and later PVR formation

So the retina turned mobile and more likely to attach in the incoming steps of the surgery

Time now for an AFX (Air Fluid Exchange) and make the eye fundus as dry as possible

Retina memory was probably unavoidable, so we had to unfold the retina towards its anatomic position, with gentle movements, stretching it out being careful not to rotate it

The macula looked pretty good and the air helped keeping it still with its surface tension

Brilliant blue was then injected in the macular area

So after fluid was back in, the retina got this bluish tint, pretty much what we needed aiming for a good ILM Peeling

Perfluorocarbon liquid was injected on the macula surface weighing on the retina and attaching it thoroughly 

Pfc should be poured very slowly to avoid it going to the subretinal space and you may observe here it opening up the peripheral retina and attaching it up to the periphery 

A small tiny ILM Cleavage was then performed and we got an edge so as to peel the ILM freely, getting it from the same point the peel was stopped and rotating the tissue around the foveal area, extending it even more peripherally

We could do it several times and it is understandable how good is PFC weighing in on retina making a pretty stable peeling, in this case like peeling an onion in a circular fashion

The wide peel will help in avoiding any contraction from ILM and even ILM remnants that could be left on the macula, thus making it more unlikely to allow cell proliferation on the peeled area

Endolaser was the next step of the surgery, we did it 3-60 degrees and the retina was attached and very stable

A Direct PFC for Silicon Oil was then carried out and, as you can see, the lens was clear at all times

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