Avoiding iatrogenic retinal breaks important in traction retinal detachment surgery
FORT LAUDERDALE, Fla. — Avoiding retinal breaks is important when treating tabletop traction retinal detachment cases, according to a speaker here.
“You have to do everything you can to not make iatrogenic retinal breaks. You have to still have scissors in your wheelhouse. You have to learn how to use scissors and maintain that skillset for these tabletop traction retinal detachment cases,” Steve Charles, MD, said at the Retina World Congress. “If you try to do it all with the cutter, you’re going to make retinal breaks.”
Beveled tip cutters, smaller cutter diameters, high-speed cutting and advanced fluidics all help make removal of the epiretinal membrane safer during surgery, Charles said. Attempting to remove the entire epiretinal membrane with the vitreous cutter could result in more retinal breaks, leading to silicone use and complications, he said.
The safest method of managing broad areas of highly adherent epiretinal membrane, Charles said, is to use curved scissors to perform inside-out delamination.
Common mistakes during surgery include forceful posterior vitreous detachment creation, membrane peeling leading to high incidence of retinal breaks, operating using a cutter only without scissors and using silicone oil as a response to making too many retinal breaks, he said. In addition, it is essential to use a 20k 25- or 27-gauge beveled tip cutter, curved scissors for access to segmentation and delamination, and laser hemostasis while avoiding using a scleral buckle or performing viscodissection.
Removing silicone oil from the eye as early as possible is important.
“Since we’ve had OCT and we looked at every detachment that we have to use oil in, the prevalence of silicone oil-made macular edema is huge and rarely reversible,” Charles said.
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Charles S. Traction retinal detachment essentials. Presented at: Retina World Congress; May 12-15, 2022; Fort Lauderdale, Fla.
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