Surgeon: David Xu, MD | Year: 2019
Dr. Xu performs a pars plana vitrectomy followed by endolaser panretinal photocoagulation (PRP) for diabetic vitreous hemorrhage. First, three vitrectomy ports are placed 4 mm from the limbus in this phakic patient. Next, a core vitrectomy is carefully performed, avoiding damage to the retina while the view is poor. Once the central vitreous is removed and the retina can be visualized, the peripheral vitreous is removed. Endolaser PRP is applied, followed by scleral depression with additional endolaser. Finally, an air-fluid exchange is performed, then the ports are removed.
PREOPERATIVE DIAGNOSIS:1. Vitreous hemorrhage, *** eye
PROCEDURE PERFORMED:1. Pars plana vitrectomy, *** eye
ANESTHESIA:MAC, topical, and peribulbar block
Prior to the date of surgery, the risks, benefits, and alternatives of the planned procedure were discussed with the patient, and informed consent was obtained. The patient was identified in the preoperative area by the attending physician, and the operative eye was marked. The patient was taken to the operative suite and given IV sedation and topical ocular anesthesia. A peribulbar block consisting of a 50:50 mixture of mepivacaine and bupivacaine was given. The operative eye was prepped and draped in the usual sterile ophthalmic fashion. A lid speculum was inserted.
A 25-gauge infusion cannula was inserted in the inferotemporal quadrant using the self-retaining port. Placement in the vitreous cavity was confirmed using direct visualization, then infusion was initiated. Self-retaining 25-gauge cannulas were inserted in the superonasal and superotemporal quadrants. The light pipe and vitrector were inserted into the vitreous cavity. The patient was noted to have a vitreous hemorrhage due to proliferative diabetic retinopathy. A core vitrectomy was performed, followed by a peripheral shave vitrectomy to ensure that all vitreous hemorrhage was adequately removed. Endolaser panretinal photocoagulation was performed in all quadrants.
The peripheral retina was meticulously inspected with scleral depression, and there were no retinal breaks present. A partial air fluid exchange was performed. The ports were removed, and the sclerostomies were inspected and found to be watertight. The eye was physiologic pressure by finger tension. Subconjunctival antibiotic was injected into the inferior fornix. The speculum and drapes were removed, antibiotic-steroid drops were placed in the eye, and a shield was placed over the eye. The patient was then transported to the recovery unit in stable condition.