First Author: G.Levytska UKRAINE
Co Author(s): I. Levytskyy Y. Alibet
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Aim to develop technique of choroid detachment and hypotension elimination during vitrectomy and determining its effectiveness.
Retinal detachment complicated by choroidal detachment and hypotension has poor prognosis due to low anatomical and functional outcome. Usually these patients are excluded in prospective studies of RRD treatment.
Vitrectomy protocols and surgery results were retrospectively analyzed in 19 eyes with RRD complicated by choroid detachment and hypotension. The exclusion criteria were previous vitreoretinal surgery, macular and giant retinal tears, eye trauma. All patients underwent standard ophthalmological examination (including visual acuity assessment, biomicroscopy, ophthalmoscopy and ocular tonometry) and ultrasound biomicroscopy. Choroid detachment (>180°) was noted in 15/19 eyes, average IOP – 7.1 ± 1.8 (5-11) mm Hg. 10 patients were myopic (range -4 to -18 dioptres). 4 patients were pseudophakic. None of the patients had PVR C. Choroid reattachment was performed before standard three-port vitrectomy.
Technique: Two sclerotomies in 3.5 or 4 mm from the limb, in the lower-temporal and one of the upper quadrants with the maximum height of choroidal detachment; perfluorodecalin injection into vitreous cavity at the site of the planned third sclerotomy using a 23 gauge needle. As a result of PFD injection subchoroidal fluid drained through prepared sclerotomies causing choroid reattachment and restoration of the eye turgor. In all cases pigment epithelium was successfully penetrated by standart length infusion cannula. Described technique led to a decreased height of retinal detachment, which in some patients facilitated vitrectomy. All patients underwent a routine vitrectomy with laser coagulation and a gas tamponade, proper volume of gas bubble was achieved. Reattachment after one surgery in 6 months term was achieved in 84.2% (16/19 eyes). Recurrence was caused by PVR. Epimacular membrane formed in two cases.
Intravitreal injection of perfluorodecalin with two sclerotomies ensures choroid reattachment, IOP restoration before vitrectomy and allows achieving an adequate volume of tamponade agent.