Macular Detachment – Vitrectomy and Iluvien Fighting – A NGENUITY 3D Capture



The authors will present a video of a 23 gauge pars plana vitrectomy (PPV) performed with the NGENUITY 3D Visualization System. The clinical case refers to a type II diabetic patient with a diffuse diabetic macular edema (DME) and a significant submacular detachment/fluid with a concomitant premacular membrane in a background of a previous PPV and silicone oil tamponade, within a context of a severe proliferative diabetic retinopathy condition. An intravitreal (IV) fluocinolone acetonide (Iluvien) implant was also introduced 3 months before the surgery. In addition to a 3D view, the NGENUITY 3D Visualization System allows to increase magnification while maintaining a wide field of view, use digital filters to customize views during each procedure, and facilitates operating using lower light levels. This new system also allows the surgeons to operate looking at a high definition 3D screen, instead of bending their necks to look through the eye-piece of a microscope, helping to improve surgeons postures and reduce fatigue. Moreover, the system is designed to facilitate collaboration and teaching in the operating room. The authors exhibit a converted 2D video in which we can follow, very accurately, the silicone oil extraction with the imminent Iluvien implant aspiration, aborted, twice, with success. Furthermore the peeling of a very sticky premacular membrane process will be showed. At, this time, at the third postoperative month, we achieved a stable clinical situation with a 0,05 best corrected visual acuity, a nonproliferative diabetic retinopathy status and the disappearance of the macular edema and submacular fluid, with the maintenance of the IV Iluvien implant. The case presented illustrates the possible nefarious effect of an excessive time with silicone oil tamponade in a proliferative diabetic retinopathy indication. The extracted sticky premacular membrane seemed to be a thickened internal limitant membrane. The pathogenesis of the important subretinal fluid observed during the preoperative period could be explained as an exsudative secondary effect promoted by the longstanding silicone oil tamponade which was also, certainly, responsible for the development of a premacular membrane, with an additional tractional component.



Bernardete Pessoa
Porto, Portugal
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