Next, any significant subretinal bands that are tenting up the retina are accessed by “punch-through retinotomy” performed using a closed forceps, said Dr. Charles, describing another technique he developed. (See Figures 4 and 5.)
Then, subretinal fluid is drained internally through the pre-existing retinal break, using a soft-tip cannula or vitreous cutter if there is potential for residual vitreous. When subretinal fluid stops decreasing during internal drainage, fluid-air exchange is started and continued simultaneously with internal drainage.
“Failure to reattach has nothing to do with poor technique, but occurs because of residual traction,” Dr. Charles added.
If the subretinal fluid stops decreasing before the retina is attached, surgeons should look for a contributing cause and can begin with a search for residual vitreous. If found, Dr. Charles recommended performing vitrectomy-under-air (“interface vitrectomy”).
“Don’t put in a perfluorocarbon liquid, triamcinolone, or infusion fluid,” Dr. Charles said. “Do vitrectomy-under-air, making sure the port is in the vitreous liquid component.”
He added that it can only be done using a peristaltic pump.