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Purpose:

To evaluate the advantages and safety of the use of chandelier endoilluminator during episcleral surgery for the treatment of retinal detachment.

Effectiveness:

The use of chandelier endoilluminator allows the surgeon to observe the fundus to locate the retinal breaks and retinal regmatogenous areas faster and with better quality than the traditional technique of visualization with an indirect ophthalmoscope and a no-contact lens. The observation with the chandelier endoilluminator and the use of the surgical microscope allows the surgeon to perform the manoeuvres of localization of retinal breaks and to perform cryopexy without holding the lens. The observation of the fundus is easier than with the indirect ophthalmoscope because the image is not inverted and makes the manoeuvres of scleral indentation more intuitive.

My Way:

The technique of the scleral buckling is identical to the traditional technique reported in the literature and commonly performed. The chandelier endoilluminator is positioned after a 360 ° conjunctival perilimbar incision is made and after hooking the extraocular muscles and threading the silk sutures. Either a 25 gauge chandelier trocar insertion or a 27 gauge chandelier with a needle guide were used.

Tips and tricks:

The observation of the fundus is performed at the surgical microscope with no contact wide-field lens. The traction sutures on the insertions of the extraocular muscles allow the surgeon to visualize the periphery of the retina and to keep the eye still during cryopexy of retinal breaks.

Conclusions:

The hands free, the clearer visualization of the fundus and the non reversed image are the advantages for the use of the chandelier endolluminator. This additional light instrument makes episcleral surgery faster and more accurated compared to the traditional tecnicque with indirect ophthalmoscope. The use of the endoilluminator chandelier did not cause iatrogenic breaks where it was inserted.

Take Home Message:

The use of the chandelier endoilluminator during episcleral surgery facilitates the localization and treatment of retinal breaks.