Ahmed: In this video,
we will show the importance
of serial OCT scans
in focal vitreomacular traction cases.
Our patient complained of drop
of vision three months ago in his right eye.
His OCT scans show a stable condition
in the last three years exaggerated
after BRB augmentation.
The plan is lens-sparing pars plana vitrectomy
with preoperative single anti-VEGF.
This is the OCT scan just prior to vitrectomy.
Starting by core vitrectomy injection
of triamcinolone acetonide,
vitreoschisis is seen trying
to segment the vitreomacular adhesions
to decrease risk of macular hole
during the delamination.
Injection of BBG stain
for better contrast over the macular area.
Using retinal pick to detect a good plane for delamination.
The membrane looks the same in clinical examination,
but firm, broad attachments were seen during the operation.
Then shifted to retinal forceps,
trying for envelope dissection.
Of course, bimanual surgery could help a lot
in this situation,
but I didn't perform here a good tangential force,
so bleeding occurred.
The source of bleeding here is obscured by membrane,
so I injected Kenalog, then raising the infusion pressure
to control this bleeding.
I decided to inject PFO to protect the macular area
and for easier dissection
of the remaining part of this membrane.
Using forceps to continue delamination,
trying to be tangential to the surface of the retina.
Epicenter is seen here, so I tried to do trimming
with the cutter for fear of creation of a retinal break.
Injection of BBG stain to reveal any residual adhesions,
then shaving with the cutter as much as possible
any residual vitreous.
Now doing shaving
of the vitreous base and internal search
for any retinal breaks.
Sclerotomy side break is seen in upper temporal quadrant.
Performing fluid-air exchange
and removing any residual PFO bubbles.
Then endolaser around the break under air
by surgeon's indentation
and silicone oil injection,
then checking again prior to suturing sclerotomies.
Patient is doing well on day one
with removal of all tractional membranes.
Single intravitreal anti-VEGF was planned on day 60.
His best-corrected vision was 6/18 at day 90 compared
to counting fingers preoperatively.
So take-home message,
regular OCT scans can help to detect duration of TRD,
which reflects on the visual outcome.
Always be ready with bimanual.
Don't hesitate it to check retinal periphery
for possible anterior breaks.