Garcia is a board certified and internationally recognized researcher and clinician. Surgery and Treatment of Diseases of Retina and Vitreousĭr. Bakri suggested to do scleral depression multiple times to “jiggle” away the silicone oil bubbles away from the ciliary body.Charles A. Kourous Rezaei advised to do multiple fluid-air exchanges to get rid of as much silicone oil as possible. This was caused by the infusion nicking the retina during scleral depression.īryon Ladd, MD (Midlothian, VA) lastly showed a case of a complicated retinal detachment with proliferative vitreoretinopathy in which he used the backflush from the cutter to spray PFO and silicone oil from the retina and ciliary body. Acnes, and to send half of the biopsy sample for special stains and send the other half to microbiology.Īrshad Khanani, MD (Reno, NV) discussed a case of an ERM peel that was complicated by retinal detachment that formed due to subretinal infusion of BSS. Harry Flynn suggested to obtain anaerobic cultures for P. He eventually explanted the IOL after the patient presented with a hypopyon. Acnes endophthalmitis in a patient with 20/20 vision, in which he delayed surgery with every 2 month intravitreal injections of vancomycin. Kourous Rezaei, MD described a case of P. He peeled retinal membranes, which were also thought to be fungus. White opacities noted in the vitreous were thought to be fungal elements. Kasra Rezaei, MD (University of Washington, Seattle, WA) discussed a case of Propionibacterium Acnes chronic endophthalmitis, which required removal of a 3 piece IOL and the capsule. Harry Flynn chimed in from the fact-checking booth to share a paper regarding nonsurgical management of submacular hemorrhage caused by RAM, which concluded that good visual outcomes can be achieved with observation. SF6 tamponade was placed after the ILM was peeled. The panel debated whether it was better to inject subretinal TPA first or peel the ILM first in this case.
The goal of the surgery was to displace the hemorrhage and close the hole. Sophie Bakri, MD (Mayo Clinic, Rochester, MN) showed a case of a retinal artery macroaneurysm (RAM) that caused submacular hemorrhage and macular hole. Rezaei advised to keep in mind that the retinotomy is frequently bigger than you expected. The patient in his video ended up with 20/20 vision after the procedure.
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He infuses tissue plasminogen activator (TPA) under the subretinal space while under air, then applies laser around the retinotomy site. John Pitcher, MD (Albuquerque, NM) discussed subretinal hemorrhage pneumatic displacement. Rezaei also recommended to complete any part of the surgery that requires a chandlelier before staining with ICG to minimize light toxicity. It was emphasized that one should not miss a peripheral retinal tear by assuming the macular hole was the only break responsible for the retinal detachment. Other challenges include peeling ILM on a detached retina due to lack of counter-traction, along with using perfluorocarbon liquids to prevent ICG from entering the subretinal space. Rezaei opined that he prefers to avoid draining from the macular hole because the thickness of the subretinal fluid can cause enlargement of the hole. Mura did not believe this to be a concern, though Dr. One point of discussion was whether one should be concerned with enlarging the macular hole if they use it as a site for drainage of subretinal fluid. Marco Mura, MD (Baltimore, MD) discussed retinal detachments associated with macular holes. Houston also described a case of a traumatic cataract associated with ruptured globe, in which he waited 2 weeks after the initial closure to place a sulcus IOL and clear vitreous hemorrhage. He prefers to bury the Gore-Tex knot in one sclerotomy on each side, while suturing the other one closed. He uses 25-gauge trocar ports for this surgery. Steven Houston III, MD (Lake Mary, FL) discussed Gore-Tex scleral fixation of the Akreos A060 lens for eyes with poor capsular support. The session was moderated by Kourous Rezaei, MD of Rush University Medical Center/Illinois Retina Associates. A panel of vitreoretinal surgeons shared videos of complex cases and discussed surgical techniques. Session 6 of the VBS 6 th annual meeting was a special Retinaws session.
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