DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSES:
Epiretinal membrane, macular edema, background diabetic retinopathy, left eye.
POSTOPERATIVE DIAGNOSES:
Epiretinal membrane, macular edema, background diabetic retinopathy, left eye.
OPERATION PERFORMED:
Pars plana vitrectomy, membrane peeling, left eye.
COMPLICATIONS: None.
ANESTHESIA: Monitored anesthesia care.
DESCRIPTION OF OPERATION: After obtaining informed consent, the patient was brought into the operating room where he received a left peribulbar block. Under sedation, the left eye was prepped and draped in sterile fashion. A lid speculum was placed. Then, 25-gauge trocars were placed 3 mm posterior to the limbus. The first one to be inserted was inferotemporally, where an infusion port was attached and turned on after inspection. The other two were inserted superotemporally and superonasally, through which a vitrectomy was started using a vitrector.
After removing the core vitreous, cortical vitrectomy was performed at 360 degrees. There was an epiretinal membrane with macular edema. We placed a contact lens and peeled the epiretinal membrane using end-gripping forceps. It started to peel about 2 cm away from the fovea inferiorly and the epiretinal membrane came out in its entirety. Given the diabetic status and the several scientific publications indicating an improvement with peeling of the ILM, we decided to peel this as well, and it was not easily visible, and after a couple of attempts, we decided to inject ICG at a concentration of 1 in 10. We left it in the eye and removed it from the eye immediately with active suction from the vitrector. This achieved a very slight stained, barely visible ILM, but enough to be able to peel it in its entirety from the macular region. There were no complications.
Scleral depressed exam, 300 degrees, did not find any pathology that required treatment. There were multiple intraretinal hemorrhages in the posterior pole and mid periphery, related to the diabetes. We injected Kenalog 4 mg and then removed the trocars. We then injected subconjunctival antibiotic and steroid, applied topical antibiotic and Alphagan and patched this over the eye.
At the end of the case, the pressure of the eye was left at about 15 mmHg. All sclerotomies were watertight and the retina was fully attached with all retinal vessels patent. The patient was taken to the recovery room having tolerated the procedure well.
