2.20 Chandelier Systems and Bimanual Surgery

indentation and cutter. This can be useful in complex procedures such as:

¥Diabetic tractional retinal detachment

¥Diabetic combined rhegmatogenous and tractional retinal detachment

¥Retinectomy surgery for PVR

¥Trauma

In 25-gauge surgery, chandeliers are often required

because poor mobility of the eye requires the surgeon to

Surgical Pearl of Wisdom

When performing a vitrectomy and lensectomy, it is often possible to preserve the anterior lens capsule for future placement of a posterior chamber implant lens. However, when the procedure is combined with a gasÐ ßuid exchange, synaechiae may form between the iris and lens capsule. In addition, peripheral anterior synaechiae may form as well, leading to postoperative, chronic angle closure glaucoma. Just prior to the gasÐ ßuid exchange, I inject a small amount of viscoelastic in the angle and between the iris and the anterior lens capsule. This may result in a temporary elevation in the intraocular pressure, but it can usually be controlled medically. In this situation, I also prescribe acetazolamide 500 mg immediately postoperatively. Posterior synaechiae formation can also be avoided by using tropicamide or cyclopentolate eye drops to keep the iris mobile after the surgery.

Andrew W. Eller, The Eye & Ear Institute, University of Pittsburgh School of Medicine, Pittsburgh, USA

Fig. 2.77 A simple two-optic chandelier is inserted by Þrst creating the incisions in the sclera with a needle; be careful not to lose the location of the incisions; therefore, remove the needle at the same time as inserting the chandelier tip

2.20Chandelier Systems and Bimanual Surgery

Using specialised lens systems can allow the illumination of the retina by the microscope lamp (Horiguchi et al. 2002). Alternatively, self-retaining chandelier Þbre-optic lights can be used, to avoid the use of the manual Þbre-optic illumination. A high-output light source is required, for example, xenon to provide adequate illumination. There are various designs of Þbre optic (single optic and twin optics), which can be placed in the pars plana at a convenient site which does not interfere with surgery usually 6 or 12 oÕclock. The chandelier frees up the second hand to allow the use of two instruments in the eye, for example, scissors and forceps or

Fig. 2.78 In this case two chandeliers have been inserted in an inferior position