First Author: P.Tyagi UK
Co Author(s): V. Hegde
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To demonstrate the technique of repair of giant retinal tear (GRT) in eye with adherent leucoma
Aberdeen Royal Infirmary, Aberdeen, Scotland. United Kingdom.
A 40-year-old man presented with nasal visual field defect in left eye for 2 days. He had a history of penetrating eye injury and three subsequent ocular surgeries at the age of 2 years. Left eye had distorted anterior segment, traumatic partial aniridia, paracentral adherent leukoma and cataract. Fundus showed temporal macula-off rhegmatogenous retinal detachment (RRD) with giant retinal tear (GRT) extending from 12 to 6 o’ clock. He underwent 23 gauge pars plana vitrectomy with silicon oil endotamponade along with phacoemulsification and posterior chamber intraocular lens implant (PCIOL) implant.
The cataract surgery required release of iris synechiae to corneal scar, capsulorrhexis without capsular stain and use of low phaco power settings for removal of soft cataract. The posterior segment visualization was improved by view through clear corneal window and use of chandelier endo-illumination. Perfluorocarbon liquid (PFCL) was used to unroll GRT edge, drain subretinal fluid from under GRT edge and flatten retina. The vitreous base and anterior retina was shaved and the margin and horn of GRT was treated with near confluent endolaser burns. PFCL silicon oil (SO) 5000cs exchange was done. SO endotamponade was kept for 3 months.
Anterior segment trauma with corneal scars, iris defects and synechiae, angle distortion and lens damage presents challenging situation for vitreoretinal surgery. Iris synechiolysis must be done with sharp and blunt dissection. Anterior capsular stains must be avoided to prevent corneal staining from endothelial defects. Posterior segment visibility can be improved by view through clear corneal window and use of chandelier endo-illumination. Chandelier light provides good view of retina and allows bimanual indentation and laser by operating surgeon. The marking of GRT edge by endo-diathermy allows good endolaser of flat retina under PFCL. PFCL/SO exchange prevents slippage of GRT edge.