Additional lighting (chandelier/twin light) in combined MICS and 23 G sutureless vitrectomy (TSV) for macular pucker and macular hole

Poster Details

First Author: G.Santin ITALY

Co Author(s):    C. Chierego   R. Pizzi   R. Bellucci        

Abstract Details

Purpose:

To reduce the incidence of intra and postoperative complications in patients undergoing combined MICS and 23 G TSV for macular pucker and macular hole, the use of additional light sources (chandelier or twin light) is recommended. Additional lighting allows continuous monitoring of the major part of the retina (in conjunction with no contact wide-field optical systems) during all phases of the intervention. In addition, the surgeon can practice bimanual manoeuvres and can exercise scleral indentation for endolaser and cryo treatment or introduce fluid, gas and silicon oil more precisely and without the help of a second surgeon.

Setting:

Ophthalmic Unit, Hospital and University of Verona, Italy.

Methods:

We considered a series of 200 consecutive patients operated on for cataract and macular hole or macular pucker over a 24 month period. All cases were operated on by MICS and 23G TSV. In addition to the optical fibre included in the custom pack, an additional source of illumination (chandelier twin light or ) was used in all cases. The difficulties of the vitrectomy maneuvers and the incidence of complication were considered.

Results:

Vitrectomy manoeuvres could be performed bimanually. Indentation to control the peripheral retina did non require a second surgeon. When necessary laser treatment or cryotreatment were carried out . During gas or silicon oil exchange the lighting system allowed simultaneous control of the central and of the peripheral retina. Intraoperative complications (vessel damage or retinal touch) were fully checked using the additional lighting systems. In the 200 cases studied, we had 1 retinal detachment after macular hole which occurred 15 days after surgery and was resolved by vitrectomy revision and silicone oil injection. In 2 cases there were tyndall blood in the vitreous cavity which abdsorbed after 15 days. In 4 cases we had intraoperative bleeding because of direct retinal vessel injury or retinal touch. These complications were resolved by increasing pressure in the vitreus cavity and with endolaser photocoagulation without any appreciable consequences .

Conclusions:

The additional lighting was of great help during maneuvers and further reduced intra and postoperative complications 23 G TSV after MICS and also allowsd significant improvement in the control of both mild and severe intraoperative complications FINANCIAL DISCLOSURE?: No