Achieving the best visual outcomes in challenging cases is a high priority in surgical retina. However, meeting that goal involves a high level of creativity, especially in complex cases associated with other ocular comorbidities.
Ronald Gentile, MD, described some of the tools he uses that ease the tension in the operating room and make the postoperative course uneventful.
“Surgery is built on a solid foundation of the previous step,” Dr. Gentile said. “The ideal operating room experience should be calm and stress-free for all. We are really searching for operating room nirvana.”
Dr. Gentile is clinical professor of ophthalmology, director of the Ocular Trauma Service (posterior segment), and coordinator of the Retina Service, The New York Eye and Ear Infirmary of Mount Sinai, affiliated with the Icahn School of Medicine, New York.
He explained that there are some simple and effective gadgets and techniques that can prevent intraoperative and postoperative surprises, making the lives of all involved in the surgery much easier during and after the surgery.
Complex diabetic vitrectomy
Dr. Gentile explained how he approaches what can be a scary scenario of a combined tractional rhegmatogenous retinal detachment in which the membranes extend past the equator. The rhegmatogenous component makes this an extremely challenging case.
He uses valved trochars, which decreases flow. “Previous to this, we had leaking sclerotomies that caused the retina to be extremely mobile, making it very difficult to remove some of the membranes,” Dr. Gentile explained.
While not a new instrument, the MPC membrane cutter/peeler enables the surgeon to get into tight membranes, especially in the retinal periphery, and remove plaque that can be adherent to the retina. Available in small gauges, this instrument can hit these tight membranes without causing additional retinal breaks.
“In the past, we actually had to remove the retina to remove the plaque, especially if there was an adjacent retinal break,” Dr. Gentile added..
The new chandeliers provide substantial illumination in the surgical space and facilitate bimanual surgery.