Surgical Pearls

1. Problem: Subretinal PFCL.

Solution: Aspirate PFCL with 41G cannula (Figs. 12.1–12.3). Attach a 41G cannula (DORC, Synergetics) on active aspiration, insert the cannula transretinally into the PFCL bubble and aspirate it. The retinal hole requires no laser.

2.Problem: Subretinal silicone oil (behind a retinal tear).

Solution: Inject BSS between the big silicone oil bubble in the vitreous cavity and the small silicone oil bubble under the retina. The BSS will separate the big bubble from the small bubble. Then squeeze the small oil bubble out through the retinal tear with the spatula. If the silicone oil bubble is not located under the tear then move it there with the knob spatula.

3.Problem: Prophylactic treatment of PCO (Figs. 12.4–12.6).

Solution: If you perform a combined phaco/PPV you may intraoperatively cut a hole in the posterior capsule. Cut a round hole in the centre of the posterior capsule with the vitreous cutter (cut 400/min). The IOL will not luxate and the posterior opening because circular will not tear.

4.Problem: Iris capture after combined phaco/PPV.

Solution: Attach a 27G cannula (grey cannula) onto a 2 ml syringe. Position the patient at the slit lamp. Drop topical anaesthesia + povidone iod. Perform a paracentesis and press the optic with the cannula behind the iris.

5.Problem: Retinal fold after PPV for retinal detachment. Postoperative slippage of the retina may occur in PPVs for retinal detachment secondary to a giant tear (Figs. 12.7–12.9).

DVD

Video 18 Management of a macular fold

Solution: Induce a retinal detachment with a 41G active injection cannula (DORC). Perform a fluid/air exchange in order to increase the detachment at the posterior pole. Inject PFCL and massage the retina with a knob spatula or Tano diamond dusted membrane scraper. Perform a gas or silicone oil tamponade.

DVD

Video 19 Macular translocation

Fig. 12.1 42G cannula from Synergetics attached to the active aspiration port

Fig. 12.2 The cannula is inserted into the vitreous cavity and is located just above the subretinal PFCL bubble

Fig. 12.3 The cannula is placed transretinal into the PFCL bubble and the PFCL aspirated

Fig. 12.4 A combined phaco + PPV due to a macular hole

Fig. 12.5 The posterior capsule is aspirated by the vitreous cutter

Fig. 12.6 A round hole is cut in the posterior capsule

Fig. 12.7 Retinal fold after vitrectomy for a retinal detachment secondary

to a giant tear

Fig. 12.8 Injection of subretinal fluid with a 41G active injection cannula (DORC) to induce an artificial retinal detachment

Fig. 12.9 Fundus picture at the end of the operation. No visible retinal fold

at the posterior pole