BIMANUAL VITRECTOMY USING THE MULTIPORT ILLUMINATION SYSTEM FOR THE CREATION OF GIANT RETINOTOMIES, TREATMENT OF GIANT RETINA TEARS, AND TREATMENT OF DETACHMENTS WITH HARD TO VISUALIZE PERIPHERAL BREAKS

Mark Hammer, W. S. Grizzard (Tampa)

Purpose: To demonstrate the superior illumination and improved surgical ease of performing vitrectomy on the far per peripheral retina using the Multiport Illumination System(MIS) in combination with the microscope-mounted stereo-diagonal inverter (SDI) and binocular indirect ophthalmoscope(BIOM).

Method: The charts and operative videotapes were reviewed retrospectively for 8 patients who had vitrectomy using the MIS for far peripheral retinotomy, management of giant retinal tear, and management of detachments with difficult to visualize peripheral breaks. The panoramic view using the SDI and BIOM is further augmented by the brilliant coaxial illumination and ability of the surgeon to use two instruments or scleral depression and one instrument in an extremely controlled technique in the far peripheral retina and vitreous cavity.

Results: The eight patients ranged from 48 to 88 years in age. Six were men and 2 were women. The surgical eye was the right in 4 and left in 4. The preoperative diagnoses were recurrent PVR with RD in 5, AMD with large submacular hemorrhage in 2, and giant retinal tear in 1. The average number of prior operations was 3. The preoperative visual acuity was 20/100 in 1 patient, HM in 6 and LP in 1. The post-operative visual acuity at 2 months or less had improved to HM in 1 patient, to CF in 4, to 20/400 in 1, 20/200 in 1, and to 20/60 in 1. All 8 eyes were attached at the most recent followup visit. Hypotony was present in 4 preoperatively, but in only 2 postoperatively. Complications of postoperatively increased IOP (controlled with topical medication) occurred in 3 patients. One additional patient had a 1-mm. bubble of silicone oil in the anterior chamber. The size of the retinotomy or giant tear ranged from 150 to 270 degrees averaging 180 degrees in 6 patients. Two patients had difficult to visualize peripheral breaks but did not require retinotomy. Perflurooctane (PFO), PFO-silicone oil exchange, and endolaser were used in 7 patients while only endodrainage with fluid air exchange was used in 1 patient. Subretinal membranes were significantly removed in 4; tight retina was present in 1, and a giant tear without PVR was present in 1. Diathermy was needed in PVR retinotomy patients, but not giant tear and retinotomies at the ora for large subretinal hemorrhages. No complications due to the MIS ports occurred. The self-sealing capability of the port lumen calmed fluid motion around the giant free-edge of the detached retina and prevented sclerotomy incarceration.

Conclusion: The MIS augments the benefits of the SDI and BIOM for the far peripheral retina by allowing bimanual surgery including surgeon-performed scleral depression with one hand while operating intraoperatively with the other, delivering coaxial illumination to the surgical area of maximal interest, and controlling fluid motion during instrument exchanges.


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