Retinal Detachment secondary to Macular Hole

This is a video shared by Dr. Marlon Garcia Roa from Querétaro México

In this video, the surgeon shows a PPV indicated to treat a phakic patient with Retinal detachment secondary to Macular Hole.
Detachment of the posterior hyaloid and complete removal of epiretinal membranes is essential for successful reattachment. In cases of RDMH it’s common, the presence of adherent cortical vitreous even when PVD appears to be present.
Due to the risk of toxicity, it’s important to try to remove partially the subretinal fluid and inject the dye alway from the macular hole. Once the retina is detached and mobile, peeling has better done removing the membranes from nasal to temporal side.
In this case the surgeon decided to perform Inverted ILM peeling technique. So, the internal limiting membrane was peeled leaving the ILM  attached to the macular hole border 360º.After removing the inferior PVR, a PFCL bubble was used to help the positioning of the remaining ILM inside the macular hole. Then, endocautery was used to perform a retinotomy superiorly to help draining the residual subretinal fluid.
After fluid air exchange, the endolaser was made only in the area of retinotomy and the surgeon decided to use silicone oil as tamponade.
A second procedure to remove the cataract and silicone oil was programmed after recovery.

Marlon Garcia Roa MD
Querétaro – México

Filipe Lucatto MD
Juliana Prazeres MD
Salvador – Brazil