In this episode, guest surgeon Dr. Aaron Nagiel demonstrates the use of an endoscope to perform a vitrectomy in a patient with a uveitic retinal detachment. The patient in this case is a 16 year old with a history of pars planitis who self-discontinued her immunosuppressive therapy. She presented with a 1 day history of loss of vision and was found to have a macula-involving rhegmatogenous retinal detachment and active uveitis. Typically in uveitic eyes, intraocular surgery is delayed until the inflammation can be controlled, however the presence of a new-onset retinal detachment required urgent surgical intervention. The patient has anterior synechiae, a cataract and vitreous haze, precluding an adequate view of the retina and making scleral buckling difficult. Traditional vitrectomy with a microscope and top-down viewing may be difficult and could require synechiolysis and cataract extraction. However, in a patient with active uveitis, this may further increase inflammation and compromise her post-operative course. To manage the RD and to avoid anterior segment surgery, Dr. Nagiel uses an endoscopic approach. At the end of the case we will discuss some pros and cons of and endoscope approach as well as some pearls when performing endoscopic vitrectomy. Thank you Dr. Nagiel for sharing this case and please be sure to check out Dr. Nagiel’s endoscopic vitrectomy course. The registration link is here: https://forms.gle/L1RmRdbcaYn5KHuF9
