168 |
11 Trauma |
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Fig. 11.8 A small space for insertion of the trocars was found at 12 oÕclock. The chandelier light is placed in one of the trocar cannulas
infusion cannula. If the trocar cannula is not in the vitreous cavity, it can be freed from the surrounding tissue with a membrane pic from the opposite trocar cannula. The same procedure can now be performed with the second trocar cannula.
Pits & Pearls
Subepithelial location of trocars: Especially in eyes with choroidal haemorrhage, an initially correctly placed trocar cannula may move subepithelially during a later stage of the operation. Double-check the trocars several times during surgery.
6.Core vitrectomy
7.Injection of PFCL
If the choroidal detachment has regressed, a vitrectomy can be performed. You may need to insert a chandelier light (Fig. 11.8). Then PFCL is injected, which pushes the residual suprachoroidal blood through the sclerotomies outside. You should now check the sclerotomies (ßick the BIOM out and rotate the globe with the traction sutures). If little or no blood ßows out in an area with a high choroidal detachment, try to expel blood clots with a forceps or cotton swabs.
8. Trimming of vitreous base
Perform a thorough trimming of the vitreous base in trauma patients, in particular the anterior part of the vitreous base which extends over the ciliary body. Otherwise, the eye will develop cyclitic membranes which grow on the ciliary body and result in hypotony. Cyclitic membranes are very difÞcult to remove. The development of cyclitic membranes will increase if you use silicone oil as a tamponade.
11.2 Suprachoroidal Haemorrhage |
169 |
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Fig. 11.9 Injection of PFCL to ßatten the retina and extract more blood through the sclerotomies. Finally, PFCL is exchanged against silicone oil
9. Exchange of PFCL for silicone oil
If there is only a minor residual choroidal detachment, perform a PFCL/silicone oil exchange. The silicone oil is injected through the infusion cannula (Fig. 11.9). Suture the sclerotomies with an 8-0 Vicryl suture.
A silicone oil removal can be performed after approximately 3 months if no hypotony has developed. If you want to extend the tamponade, you can replace the silicone oil with a long-acting gas or 5,000 cSt silicone oil.