Soft-shell technique to maintain view of fundus after hemorrhage during vitrectomy in a patient with neovascular...

Intraoperative hemorrhage into the anterior chamber can hamper the view of the fundus during vitreous surgery. We report a soft-shell technique that can be used to maintain a clear view of the entire fundus after intraoperative hemorrhage.

A 56-year-old man with rubeotic glaucoma and untreated diabetic retinopathy was scheduled to undergo vitrectomy with retinal photocoagulation. However, an intraoperative hemorrhage occurred from the iris and blocked a clear view of the fundus.

The soft-shell technique was performed in which low viscoelastic material was injected into the anterior chamber followed by the injection of higher viscoelastic material. A clear surgical view of the entire fundus was obtained, and the clarity was maintained throughout peripheral vitrectomy and panretinal photocoagulation. The intraocular pressure was normalized after additional filtering surgery.

We recommend the soft-shell technique as a method for obtaining and maintaining a clear view of the posterior pole if hemorrhage occurs in the anterior chamber during vitrectomy.