Vitrectomy for Retinal Detachment Repair

This is a short video listing out the fundamental steps and maneuvers in performing vitrectomy for retinal detachment repair. Vitrectomy is currently the most commonly employed surgical technique in repairing retinal detachment.

In this case, the patient had cataract surgery performed one year prior and developed painless loss of vision over the course of one week. On examination he had an inferior macula involving bullous nasal and inferior retinal detachment. The retinal break identified during surgery was located in the the anterior portion of the eye and considered fairly small in size when compared to other types of retinal breaks. This is typical of “pseudophakic” retinal breaks, a type of small anterior retinal break thought due to traction at the vitreous base as a consequence of energy transmitted from the phacoemulsification probe used for cataract surgery.

During the surgery, note how the retinal detachment pools inferiorly while the break itself is situated in the superior portion of the eye. (The surgeon sits at the head of the bed, and thus the bottom portion of the eye seen in the video corresponds to the superior portion/top portion of the eye). This is owed to the fact that liquefied vitreous humor passes through the retinal break and, as a consequence of gravity, pools at the inferior portion of the eye.

At the conclusion of the video, gas is injected to fill the eye. The gas exerts an upward force on the retina and prevents it from detaching.  In certain cases, the patient must position his or her head (e.g. face down, right side down, left side down) to take advantage of the upward rise of the gas bubble against any retinal breaks. In this particular case, the break was located superiorly and thus the patient was asked to maintain an upright position for the better part of two weeks to allow the retinal break to seal with the endolaser scars.