Retinal Detachment Repair

These are edited videos showing the highlights of different vitreoretinal surgeries.

Vitrectomy for complex retinal detachment
Subretinal Silicone Oil

56 year old woman has had several retinal detachment surgeries locally. She noticed after the last surgery that the vision did not get better. She has a macular hole, large posterior retinal hole and subretinal silicone oil. The video shows removal of the silicone oil from the eye and then a retinectomy (cutting of the retina) to remove the subretinal oil. The retina is reattached with perfluoron, laser, and then silicone oil is placed back into the eye.

Vitrectomy for retinal detachment
23 gauge

This 67 year old woman presented with acute shadow and vision loss in her left eye. She had previous retinal detachment repair in the right eye in 2005 by me. The left eye had a temporal retinal detachment with retinal holes and lattice degeneration at 12, 1, 4, and 6. I drained the subretinal fluid through the peripheral holes. I did NOT use perfluoron nor did I create a posterior retinotomy to reattach the retina. Her vision was back to baseline for her within about 2 months of the surgery.

Vitrectomy for Retinal Detachment
and Vitreous Hemorrhage

This 64 year-old man experienced the sudden onset of many floaters. They became so dense that he lost most of his vision. By the time he came in to the office he was found to have a large amount of blood in the eye that obscured all view of the retina. An ultrasound showed the retina had detached. A vitrectomy was planned to remove the blood to visualize the retina for repair. Although vitrectomy does promote cataract formation, there was no other reliable way to repair the retina in this case. No scleral buckle was required because the single superior retinal break was sealed with laser during vitrectomy and the retina was held in position with a gas bubble.

Vitrectomy for retinal detachment
with Scleral Buckle

This 65 year-old man became aware of new dot-like floaters several weeks before coming in for evaluation and only recently noted loss of side-vision in his left eye. He had a mild cataract, but could still see 20/20. He had multiple retinal tears both superiorly and inferiorly in the retina and had two separate areas of retinal detachment. Because he did not have a significant cataract and had multiple retinal breaks, i chose to repair his retina with an encircling scleral buckle. By avoiding vitrectomy I reduced the risk of cataract formation. This retinal detachment was too far advanced for laser demarcation. The multiple inferior breaks made him a poor candidate for office pneumatic retinopexy. A segmental scleral buckle would not have supported all of the breaks and would less support to prevent additional breaks from developing in the future. See www.scottpautlermd.com for more information.

Retinal Detachment - Multiple Tears
Scleral Buckle and Vitrectomy

THIS SURGERY SHOWS SOME BLOOD. This 50 year old man had 4 days of vision loss. He had a total retinal detachment with multiple retinal breaks and lattice degeneration. He is a -12.00 myope with a dense cataract. The surgery shows retinal detachment repair with a scleral buckle (42 band and 70 sleeve) and a vitrectomy (23 gauge). Laser is used at the time of surgery and 25 percent sulfer hexafluoride gas is used as endotamponade. The surgery is done under general anesthesia. Marcaine (a long acting anesthetic) was irrigated around the eye for post-operative pain. The marcaine lasts about 8 hours. Subsequently the patient had moderate pain for about 2 days that was controlled with non-prescription pain medicines. After retinal detachment surgery, the patient positioned for a week, initially face down and then side to side.

Retinal Detachment with PVR
360 degree retinectomy

This patient had 3 previous retinal detachment surgeries and the most recent one involved a 180 degree inferior retinectomy and laser. These were all done elsewhere. This video shows a complex retinal detachment repair. Initially the hazy intraocular lens is removed. Next a macular pucker is removed and the anterior proliferative vitreoretinopathy (scar tissue) is cut. Even with those two maneuvers the retina does not reattach. A 360 degree retinectomy is performed (cutting the retina 360 degrees in the periphery) and this allows the retina to be attached with perfluoron, laser and subsequent silicone oil.

Retinal Detachment
Giant Retinal Tear - Perfluoron and Silicone Oil

This eye has a 3 clock hour retinal tear and nasal, relatively small, retinal detachment. Retinal tears that are 3 clock hours or bigger are considered "giant" retinal tears. The techniques to reattach these retinas are slightly different from those used in eyes without giant retinal tears. Perfluoron is used to flatten the retina initially. The Perfluoron is a heavier than water liquid. It rolls the retina back into its natural position and smooths out the area with the giant tear. Since this was a relatively small and very anterior (front of the eye) giant tear, I used air and gas to flatten the retina at the end of the surgery. In cases of larger giant retinal tears or more posterior giant retinal tears, silicone oil is often more appropriate.

Retinal Detachment
Scleral Buckle - Segmental

This patient had a retinal detachment with symptoms of a creeping shadow for about a week. The examination showed that some components of the retinal detachment were old. Because of the configuration of the detachment, with a single break at 7:00, it was decided to reattach the retina with a segmental scleral buckle.

Retinal Detachment
Retinopathy of Prematurity - Stage IV

Lens sparing vitrectomy. This infant had 3 laser treatments and developed a worsening nasal retinal detachment which was threatening her macula. She underwent a lens sparing 25 gauge vitrectomy with a temporal approach.

Retinal Detachment with Macular Hole
Scleral Buckle and Vitrectomy

Vitrectomy and scleral buckle for retinal detachment and macular hole. This 56 year old woman has had decreasing vision for 1 week from a retinal detachment with a macular hole. The visual acuity is 20/800. This video shows some blood because of the extensive surgery. Vision ultimately improved to 20/40 with glasses.

Retinal Detachment Subretinal Fibrosis
Removal Subretinal Fibrosis

This 80 year old man had 2 retinal detachment surgeries elsewhere. He was referred one month ago and had surgery by Dr. Cohen for a retinal detachment with subretinal and pre-retinal silicone oil and extensive preretinal fibrosis. The retina was reattached and then one month later he developed a limited retinal detachment. Interestingly, the only part of the retina that was not detached at the initial surgery was the part that detached.

Retinal Detachment
Scleral Buckler and Vitrectomy

Scleral Buckle and Vitrectomy for Retinal Detachment, This 65 year old woman had retinal detachment with decrease visual acuity for 1 week.. The visual acuity is 20/80. This video shows some blood because of the extensive surgery. The scleral buckle part of the surgery at the beginning of the surgery has some blood.