Lift-and-Shave Technique for Tractional Retinal Detachments

Dr. Maria Berrocal shares a lift-and-shave technique for repairing tractional retinal detachments. The entire surgery is performed with the vitrectomy probe and the endolaser. Using a 27-gauge, beveled, dual-port vitrectomy probe at 20,000 cuts/min, she removes the vitreous, and lifts and removes the posterior hyaloid from the periphery. Next, she isolates the fibrovascular plaque and uses the vitrector to lift the fibrovascular tissue with suction. Once resistance is encountered, the probe is used as scissors to cut adhesions. In this case, suction and cutting are alternated until all the attachments are freed. Using the maximum cutting rate allows her to shave fibrovascular tissue from the surface of the retina with minimal traction on the retina, which prevents iatrogenic breaks. After all the fibrovascular tissue is removed, laser panretinal photocoagulation is applied to the peripheral retina and an air/fluid exchange is performed. The patient’s vision improved from count fingers to 20/100 at 6 months postop.

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