Etienne H. Bovey, Jean-Antoine Pournaras (Lausanne, Switzerland)

Purpose:

To describe a new technique of surgery for pseudophakic retinal detachment, using 23G vitrectomy, slit-lamp and non-contact 90D lens.

Methods:

42 pseudophakic eyes with retinal detachment were analyzed retrospectively. They were operated on by 23G vitrectomy, transconjunctival cryocoagulation, and internal tamponade with gas (37 cases) or silicone oil (5 cases). These operations were performed by one surgeon (EHB). Visualisation of the fundus was achieved by a non-contact 90D lens, independent of the microscope. The illumination of the peripheral retina was performed by a Zeiss slit-lamp. At the end of the operation, the periphery was controlled with the optic fibre.

Results:

The mean age was 64.5 years. The macula was on in 25 eyes (59%). The mean number of tears was 2.2 and the mean size of tears was 0.5 clock hour. The internal tamponade was performed with 1 cc of air (1 case), 2 cc of air 50%-SF6 50% (5 cases), 0.7 cc of C3F8 (2 cases), 1 cc of pure SF6 (24 cases), SF6 20%-air complete exchange (5 cases) or temporary silicone oil (5 cases). The retina was reattached in 92.5% of cases. A recurrence was observed in 3 eyes (7.5%) after 2.5, 3 and 10 months. These eyes were successfully re-operated on. At the final examination, the retina was attached in all cases. The mean LogMAR visual acuity was 0.85 before surgery and 0.21 at the final examination (mean follow-up: 11.5 months). The mean visual gain was 6.4 ETDRS lines.
Slit-lamp illumination of the periphery provided sufficient view of the retina and no tear was missed with this technique.

Discussion:

The above-mentioned technique provides good post-operative results that compare favourably with other series. It gives a good panoramic viewing of the peripheral retina and allows the surgeon to indent himself the eye. This is an advantage for those who operate without an assistant.