Diabetic Retinopathy |
7 |
|
7.1Easy Proliferative Diabetic Retinopathy
You can practise the application of panretinal laser photocoagulation (PRP) very well with the 4-port technique (Fig. 7.1). In one hand, you hold the scleral depressor and indent the sclera and retina; in the other hand, you hold the laser probe and apply a PRP up to the ora serrata. In the presence of vitreous haemorrhage, a previous history of panretinal photocoagulation usually facilitates the surgery because it is associated with a higher rate of posterior vitreous detachment and promotes retinal adhesion to the RPE and choroid.
DVD
Video 9 Diabetic retinopathy
Fig. 7.1 Indentation of the peripheral retina after application of PRP. A PRP up to the ora serrata is especially easy to perform with the 4-port technique
U. Spandau, H. Heimann, Practical Handbook for Small-Gauge Vitrectomy, |
103 |
DOI 10.1007/978-3-642-23294-7_7, © Springer-Verlag Berlin Heidelberg 2012 |
|
104 |
7 Diabetic Retinopathy |
|
|
Advanced cases with tractional membranes should be operated on by an experienced surgeon. The peeling of epiretinal membranes may be difficult, and perioperative bleeding may be difficult to control.
Instruments
1.4-Port trocar with chandelier light
2.120D lens
3.Vitreous cutter
4.Fluid needle
5.Scleral depressor
6.Endodiathermy
7.Laser probe
Tamponade
Air, SF6 or silicone oil
Individual steps
1.4-Port system
2.Core vitrectomy
3.Posterior vitreous detachment and peripheral vitrectomy
4.Endodiathermy
5.Panretinal photocoagulation
6.Tamponade
7.Removal of the trocar cannulas
1. 4-Port system
2. Core vitrectomy
For details, see Sect. 5.2.
3. Posterior vitreous detachment and peripheral vitrectomy
If there are tractional membranes present at the central pole, you should not induce a posterior vitreous detachment with the vitreous cutter because this action may cause breaks in the central retina. These membranes must be removed with peeling instruments. See further in next chapter 7.2 on ‘Complicated Proliferative Diabetic Retinopathy (PDVR)’.
Pits & Pearls
PDR: Never underestimate a vitreous haemorrhage in proliferative diabetic retinopathy. Even if it may not look like a complicated situation preoperatively, there may be strong vitreoretinal adhesions at the site of even the smallest neovascular proliferations. Do not rush into such cases and try to create a quick PVD with suction over the posterior pole – try to identify and isolate each and every proliferation and treat it with great care.