O vídeo mais acessado do Retina Tips em Julho de 2019 foi sobre vitrectomia em retinopatia diabética proliferativa.
Vitrectomy for the treatment of diabetic retinopathy is one of the most challenging vitreoretinal surgeries.
We´ve listed some tips about management of this cases:
1 – The posterior hyaloid is usually attached to the retina with fibrovascular membranes in these cases. The surgeon needs to take the utmost care to avoid causing unnecessary retinal tears or bleedings.
So, try to find where the peripheral vitreous is detached, and perform a circumferential rhexis begining from the mid-periphery (from the periphery to the center). Try to perform a round rhexis as far as possible. In this case the posterior hyaloid was attached nasally and so, it wasn´t possible to perform the rhexis 360º
2 – The next step is to create openings in the posterior hyaloid and to try to disconnect the fibrovascular membranes between the arcades.
For delamination, You can either use the 23, 25 or 27 Gauge probe to enter under the hyaloid and slowly remove the bridges between arcades; or even perform bimanual techniques using combinations of forceps, scissors, flute needle or the vitreous cutter. A chandelier light is required for this step.
3 – Another important tip is to Perform a meticulous hemostasis with endodiathermy in peripheral or mid-peripheral active bleeding. You can also use the endolaser for hemostasis of small bleedings.
Try to remove all the vitreous from the periphery under scleral indentation. If necessary you can use Trypan Blue or Brilliant blue dye to remove all macular tractions. Then, complete PRP, perform FAX and when necessary inject silicone oil, or other tamponade agent in the end of the surgery.
Video:
Filipe Lucatto MD
Salvador – Brazil
Edition:
Filipe Lucatto MD
Juliana Prazeres MD
retinatips@gmail.com
