This is a case of vitreous hemorrhage in a patient with Diabetic Retinopathy. The hemorrhage was removed and then a fill in laser was done in some parts of the retina where a laser was done previously. An air fluid exchange was done at the end of the surgery.
Surgeon: Dr. Manish Nagpal, Retina Foundation & Eye Research Centre, Ahmedabad, India
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Dr. Manish Nagpal: This is a case of a vitreous hemorrhage in diabetic retinopathy. This patient has been lasered in the past but has had a vitreous hemorrhage nevertheless. You can see that there’s a lot of hemorrhage which has been cleared with the cutter in the core area at the moment. And as we keep clearing the view of the fundus, gradually keeps on increasing. You can also see the laser marks which are sealed. Some of them are pigmented because they are old and have a scarring around them. And then you can also see some hemorrhages over the retina.
There’s also a sub hyaloid blood spattered over the macular area. At the moment, we are clearing the peripheral vitreous, and then go and aspirate the sub-hyaloid blood with the cutter. Now, you can get a good view of the macular on this. And also the blahed from the surface of the retina has been cleaned up.
Some of the retina vessels have also seen scleritis, which is, again, typical of diabetic retinopathy. We removed some of the residual vitreous, as well as clean the whole fundus for any residual blood or proliferations, if visible.
After that, endolaser is done. Since this patient has already had PRP, now we do fill in laser to some of the areas in between the laser marks, old laser marks, and also the peripheral area which has not been so far lasered. This is to reduce the chance of future occurrence of a similar hemorrhage so that we can regress the retinopathy very well with a good laser all around.
After that, fluid-air exchange is done. I like to leave the air before we close so that chances of hypotony and wound leak are much less. Gradually the fluid has been exchanged with air. Now, we just are removing the peripheral spread of the vitreous which is seen much better with the air inside the vitreous cavity. As well as clean the fundus in a manner so as to find any adrenergic breaks at this stage.
January 31, 2018