DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSES:
1. Recurrent retinal detachment with proliferative vitreoretinopathy in the right eye.
2. Elevated intraocular pressure associated with retained silicone oil in the right eye.
POSTOPERATIVE DIAGNOSES:
1. Recurrent retinal detachment with proliferative vitreoretinopathy in the right eye.
2. Elevated intraocular pressure associated with retained silicone oil in the right eye.
OPERATIONS PERFORMED: Removal of silicone oil, pars plana vitrectomy, membrane peel, retinectomy, use of Perfluoron liquid, fluid-air exchange, endolaser and reinjection of silicone oil, all done in the right eye.
SURGEON: John Doe, MD
ANESTHESIA: Retrobulbar with monitored anesthesia care.
COMPLICATIONS: None.
DESCRIPTION OF OPERATION: The patient was brought back to the operating room where appropriate blood pressure and cardiac monitoring were established. The patient underwent retrobulbar injection of 4% lidocaine and 0.75% Marcaine in a 1:1 mix under mild IV sedation. The patient was then prepped and draped in typical sterile fashion for ophthalmic surgery. Superior nasal and temporal conjunctival peritomies were then created. Hemostasis was then obtained using cautery. An infusion cannula was now inserted in the inferior temporal quadrant, approximately 3 mm posterior to the limbus. The infusion cannula was confirmed to be in appropriate position prior to initiating infusion. Once this was done, the MVR blade was used to make superonasal and superotemporal sclerotomies, again approximately 3 mm posterior to the limbus. The retained silicone oil was now removed. All of the emulsified silicone oil was aspirated from the anterior chamber and anterior chamber angle at this time. Once this was done, the light pipe and vitrector were inserted into the eye and vitrectomy was performed under wide-field visualization using the BIOM lens system. Most of the formed vitreous had been removed at the time of her previous surgery, but a small amount of residual vitreous skirt was removed at this time. Once this was done, membrane peeling was initiated.
A barbed MVR blade was used to elevate dense epiretinal membrane from the macular surface. Once adequately elevated, intraocular forceps were used to peel this continuous sheet of membrane from across the macula. There was significant relaxation of the macula once this was done. A second dense epiretinal membrane was now peeled from the superior mid periphery. This again allowed relaxation of the attached retina in this area.
Once this was done, attention was turned to the detached retina inferiorly. There was extensive epiretinal and subretinal membranes formation. Although the epiretinal membranes were peeled using intraocular forceps, the subretinal membranes could not be adequately mobilized. At this point, a retinectomy was felt to be necessary. Intraocular diathermy was used to demarcate a large area of scarred retina inferiorly. This extended across from the 4 o’clock position infratemporally to the 8 o’clock position inferonasally. Once this was done, the vitrectomy instrument was used to dissect the anterior detached retina, creating a large retinectomy. The retina was dissected out into the periphery all the way to the ora serrata along this entire area. There was significant mobilization of the residual detached retina once this was done.
At this point, Perfluoron liquid was injected into the eye and used to stabilize the retina in this area. An air-fluid exchange was then initiated. Subretinal fluid was aspirated through the large retinectomy inferiorly. There was nice reattachment of the retina once this was done. All of the Perfluoron liquid was then removed. The retina was nicely reattached without any significant slippage. Endolaser photocoagulation was now concentrated inferiorly along the large retinectomy. Laser was carefully applied at the edges of the retinectomy, both near the 4 o’clock and 8 o’clock positions. Laser was then extended across superiorly, completing a 360 degrees laser barricade. Once this was done, all the residual fluid was aspirated from the vitreous cavity ensuring a complete air fill. The superonasal sclerotomy was then closed using a 7-0 Vicryl suture. The Vicryl suture was then preplaced across the temporal sclerotomy. A silicone oil fill was then performed. Silicone oil was injected into the vitreous cavity through the temporal sclerotomy. Once the vitreous cavity was completely filled with silicone oil, the temporal sclerotomy was closed using a 7-0 Vicryl suture. The infusion cannula was then removed and sclerotomy was also closed in a similar fashion.
All the wounds were reinspected and confirmed to be well sealed and the eye had an appropriate intraocular pressure. The conjunctiva was then reapposed using a 7-0 Vicryl suture. Subconjunctival injection of antibiotics and Solu-Medrol was then performed. A sub-Tenon Kenalog injection was performed for chronic postoperative inflammation control. Antibiotic ointment was then placed on the eye and the eye was patched in typical fashion for ophthalmic surgery. The patient tolerated the procedure well and was transferred to the recovery room in good condition.
