Poster Chi Wai Tsang

Advantages:

No extra instruments or material are needed to hold the floating retina. This maneuver allows safer removal of the subretinal blood clot and choroidal neovascular complex, control of bleeding and both RPE graft harvest and transferral to the recipient site. The fixation can spare one hand which may need to manipulate the floating retina, otherwise.

Methods:

A 63-year-old woman presented with 1-month history of massive subretinal macular hemorrhage and vitreous hemorrhage of her left eye associated with age-related macular degeneration. The visual acuity was light perception. The combined phacovitrectomy, intraocular lens implantation, temporal 180 degree retinotomy, autologous RPE transplantation and silicone oil tamponade was performed. The operation was performed under general anaesthesia. Combined phacovitrectomy was performed with 20G instrumentarium under BIOM wide angle viewing system. 27G twinlight chandelier system was used to facilitate the procedure. After the induction of retinal detachment by 41 G cannula, temporal 180 degree retinotomy was performed to expose the underlying subretinal space. However, the detached retina floated in the vitreous cavity, obscuring the view or even blocking the instruments, retinal trauma may occur with repeated manipulations. This problem could be solved by creating another nasal sclerotomy and the retina was induced to incarcerate into the extra sclerotomy site by gentle pulling of the retina with soft silicone tube. This method allowed temporary retinal fixation and eased the subsequent steps. The retinotomy should be as peripheral as possible, which not only reduces the risk of bleeding and subsequent rate of proliferative vitreoretinopathy, but also ensures enough tissue for incarceration. Secondly, the peripheral retinotomy should be slightly larger than 180 degree to the level of optic disc to allow adequate tissue for incarceration and better exposure for the subfoveal space.

Effectiveness / Safety:

The process of RPE transplantation was facilitated.