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NOVEL SURGICAL TECHNIQUE FOR INDUCING POSTERIOR VITREOUS DETACHMENT DURING PARS PLANA VITRECTOMY FOR PEDIATRIC
Linda A Cernichiaro-Espinosa1, Audina M Berrocal
1Pediatric Retina, Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, Miami, Florida.
Insights
A novel flexible loop technique safely and efficiently induces posterior vitreous detachment in pediatric vitrectomy, improving vision and aiding retinal reattachment.
Area of Science:
- Ophthalmology
- Pediatric Surgery
- Retinal Diseases
Background:
- Pediatric vitreoretinal diseases present unique surgical challenges.
- Posterior vitreous detachment (PVD) is a critical step in vitrectomy.
- Pharmacologic vitreolysis for PVD has reported adverse effects.
Purpose:
Vitreoretinal surgical diseases in children are challenging because of the complex features of the vitreous, retina, and the interface between them. Posterior vitreous detachment is a crucial step during vitrectomy. To date, pharmacologic vitreolysis that liquefies the vitreous and disrupts the posterior hyaloid attachment to the retina has been studied. However, there are reports of unexplained adverse effects. We describe a case performed with a reproducible, safe and time-saving technique using a commercially available flexible loop for posterior vitreous detachment induction in a pediatric patient.
Methods:
A 10-year-old boy with previously treated retinopathy of prematurity undergoes a 25-gauge pars plana vitrectomy for retina detachment repair. To achieve a posterior vitreous detachment, a flexible loop was used to grasp and pick the vitreoretinal interface around the optic nerve for dissection of the posterior hyaloid, followed by aspiration and cutting with the vitrectomy probe to complete the vitrectomy.
Results:
At 3 months follow-up, total retinal reattachment was observed. The patient's vision improved from 20/400 to 20/150.
Conclusion:
Posterior vitreous detachment induction with a flexible loop instead of pharmacologic vitreolysis seems a promising tool as demonstrated in this clinical case. Further studies to demonstrate long-term safety and anatomical results are needed.
