Bimanual 25-gauge chandelier technique for direct perfluorocarbon liquid-silicone oil exchange in retinal detachments associated with giant retinal tear

Abstract

Direct perfluorocarbon liquid (PFCL)-silicone oil exchange presents its own set of challenges in the micro incision vitreous surgery era. We propose a simple bimanual technique to circumvent this problem. Thirteen eyes of patients with retinal detachment associated with giant retinal tears underwent vitrectomy followed by self-retaining endo illuminator (Chandelier) assisted direct PFCL-silicone exchange. No intra or postoperative complications related to the surgical technique were noted. All patients had attached retinas and satisfactory visual recovery at 6 months. Direct bimanual PFCL silicone oil exchange using a Chandelier seems to be a safe and effective technique.

Keywords: Chandelier; giant tear retina; perfluorocarbon liquid; silicone oil.

Figure 1

Representative preoperative fundus photograph showing a temporal GTR superotemporally. The GTR extended from 2 ′o clock to 5 ′o clock, however, the complete edge of the temporal GTR could not captured owing to peripheral location of the tear)

Figure 2

Intraoperative photograph showing perfluorocarbon liquid bubble in situ. The temporal edge of the GTR is seen clearly in the photograph

Figure 3

Intraoperative picture showing settled retina with laser marks at edge of GTR

Figure 4

Representative picture showing chandelier assisted direct perfluorocarbon liquid-silicone oil exchange. Superiorly illumination provided by the chandelier is seen. The flute needle is kept in the dominant hand, and the tip is seen to be within the perfluorocarbon liquid bubble. The silicone oil is being injected into the eye through the other port and is seen entering the vitreous cavity above the perfluorocarbon liquid bubble

Figure 5

Postoperative picture showing well attached retina with silicon oil in situ (the GTR edge cannot be seen owing to peripheral location of the lasered tear)