aChandelier Accurus 8065751574 b23-gauge chandelier light 3269.EB06 c25-gauge Awh chandelier 56.20.25

Fig. 6.2 A 23-gauge chandelier light from DORC, which is very easy to insert because it is placed in a trocar. Similar chandelier lights are available from Alcon and Synergetics

The chandelier light is best positioned inferonasally because here, its location does not affect the rotation of the eye. The 12 o’clock or 6 o’clock insertion sites disturb the rotation of the globe, and the light fibre is easily dislocated when the globe is rotated upwards or downwards. The rigid cable allows bending of the light fibre and henceforth the ability to manoeuvre the light to different directions in the vitreous cavity. Only external light sources (Photon or Xenon) have enough power for a sufficient illumination of the vitreous cavity.

6.1Insertion of Chandelier Light

DVD

Video 8 Insertion of a chandelier light

If you have never used a chandelier light before, then start with one which can easily be inserted. The 25-gauge chandelier light from ALCON and the 23-gauge chandelier light from DORC are relatively unproblematic to use (see Table 6.1) as the light fibre can be placed inside a normal one-step trocar (Figs. 6.2 and 6.3).

Fig. 6.3 Same 23-gauge chandelier light. Place inferonasally, a one-step 23-gauge trocar. Then insert the light fibre into an ALCON or DORC trocar (with or without valve). DORC: 23-gauge chandelier light 3269.EB06

Fig. 6.4 Practical approach for the insertion of the chandelier light. The hand rotates the eyeball with the cotton wool swab in order to have space inferonasally

The chandelier light from Synergetics is trickier to be put in place but, on the other hand, provides an excellent panoramic illumination of the vitreous cavity. Rotate the globe with a swab in a superotemporal direction so that there is space for the insertion of the chandelier light inferonasally. With the sclerotomy needle supplied by the manufacturer, one first performs a transconjunctival sclerotomy 3.5 mm posterior to the limbus with a perpendicular (not lamellar) path. The chandelier light is then inserted into the sclerotomy. This procedure requires some practice (Figs. 6.4–6.7). The Synergetics chandelier light requires an external photon light source. By bending the rigid cable of the chandelier light, you can manipulate the light source. Sometimes you need to tape the cable to the drape.

Fig. 6.7 Take the chandelier optic fibre in the right hand and press it through the orifice in the conjunctiva and sclera into the vitreous cavity. Exert a significant insertion pressure. When the eye is already vitrectomized, use a 23-gauge needle instead of the supplied 25-gauge sclerotomy needle as the eyeball can indent too much

The following surgeries in bimanual technique are listed in increasing levels of difficulty. An exception is PDVR, which has been included in the diabetes section for pathological reasons. But PDVR is, in fact, a very demanding surgery similar to PVR.