Managing Retinal and Hemorrhagic Choroidal Detachments in Marfan Syndrome

Drs. Nika Bagheri and Harry Flynn Jr. repair a total retinal detachment with hemorrhagic choroidal detachment in a 43-year-old patient with Marfan syndrome. His clinical history included DSEK surgery and he was on a course of anticoagulants. After placing 23-gauge ports, the surgeons initiated a core vitrectomy. Endodiathermy was applied to create a drainage retinomoty. The superotermporal trocar was removed, and a 20-gauge MVR blade was used to enlarge the sclerotomy. After draining blood and opening the conjunctiva, they inserted a 20-gauge cannulated extrusion needle, threaded it through the retinotomy and directed it posteriorly toward the optic nerve. The retinotomy site was lasered and 360 degree laser was applied to the vitreous base. The fluid-air exchange was completed and a silicone oil-air exchange was performed. At last follow-up, the patient's visual acuity improved from light perception to 21/50.

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