In part 5 of our series of videos demonstrating the multiple steps in PVR-associated retinal detachment repair, we will be creating peripheral iridectomies (PI’s) and performing an air-fluid exchange. At this stage of the surgery, the patient’s lens and capsule have been removed and an inferior retinectomy has been created. The posterior pole is filled with PFCL to cover the retina and to keep it attached. Overlying the PFCL is balanced salt solution which is being infused through our infusion line.
An inferior PI is created in order to prevent pupillary block in the post-operative period. In the video we discuss some potential complications such as bleeding, making the PI too large and potential removal of iris tissue in an unintended location.
After creating a PI, we perform an air-fluid exchange to remove the PFCL and confirm that the retina is flat under air. While performing an air-fluid exchange our goal is to keep the retinectomy edge covered by PFCL by rotating the eye inferiorly and keeping our soft-tipped cannula in the BSS while we exchange BSS for air. Once the eye is filled with air anteriorly and PFCL posteriorly, we remove PFCL until the eye is completely air-filled. In this video we discuss strategies for optimizing visualization and ensuring that all the PFCL has been removed.
