13 Feb Total Retinal Detachment Repaired with 25 gauge Vitrectomy
This retinal detachment was repaired with a 25 gauge vitrectomy and gas. The patient was awake, but the eye was completely numbed. The surgery took place at Woodburn Surgery Center in Annandale/Fairfax, Virginia.
Vitrectomy for Retinal Detachment
Vitrectomy alone has become very popular for repairing a retinal detachment. Other choices include pneumatic retinopexy (an in-office procedure), scleral buckle, or vitrectomy with scleral buckle.
Retina specialists differ in their own preference for certain techniques. I often choose vitrectomy alone or vitrectomy with scleral buckle. These are the two most successful methods. Remember, retinal detachments aren’t always fixed the first time and are sometimes not fixable.
The vitrectomy requires installation of 3 ports or trocars. Two ports are reserved for each hand and the 3rd port is hooked up to a tube which keeps the eye pumped with either saline or air.
With 25 gauge vitrectomy systems, as in this case, the blue trocars are simply pushed into the eye. The holes are so small that they are regarded as self-sealing. Sutures are not required at the end of surgery and healing is much faster.
The first step of the vitrectomy is to remove the vitreous. You can note a PVD, complete detachment of the retina, two holes/tears and detachment of the macula. The patient barely has a cataract and has not had cataract surgery. As I move around the eye, I am also examining the retina looking for all possible tears or holes which led to this “rhegmatogenous” retinal detachment.
Rhegmatogenous retinal detachment are the most common and are caused by holes, or “rhegma,”
Macular Detachment
At the start of the operation, note how difficult it is to see the macula. As the retina becomes “less detached” the typical brown/yellow appearance of the macula becomes more apparent. The macula is the functional center of the retina and provides the capability of us to see 20/20. The remaining portions of our retina provide peripheral vision.
Macular detachment can alter the visual outcome of surgery.
Fluid-Air Exchange
After I have identified the two tears and marked them with cautery (turning the tissue white), I also created a 3rd hole called a retinotomy.
Drainage of the sub-retinal fluid occurs through the 3rd hole (retinotomy). Sometimes if a hole or tear is more conveniently located, I can skip the part of a retinotomy. At the end of the fluid-air exchange, the retina is completely attached.
The gas will be absorbed slowly over the next two weeks. Retina specialists vary as to the type of gas and mixture (concentration) used. I commonly use 16% SF6. Other gases/mixtures can take longer.
As the gas is absorbed, there is always a concern of the retina detaching again.
Laser Treatment
Having identified and marked all the tears, I can easily see where to use/aim the laser. When the fluid-air exchange is completed, unmarked retinal holes can become invisible.
The idea of laser is to induce scar formation to the layer underneath. This prevents redetachment from the same tears as the gas is absorbed by the eye.
The key to successful retinal detachment surgery is identifying all the tears and treating them all successfully.
Air-Gas Exchange
The very last step of the operation involves replacement of the air with a special inert gas.
The gas will be absorbed slowly over the next two weeks. Retina specialists vary as to the type of gas and mixture (concentration) used. I commonly use 16% SF6. Other gases/mixtures can take longer.
As the gas is absorbed, there is always a concern of the retina detaching again.
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