Proliferative Diabetic Retinopathy Vitrectomy Tips and Tricks / RDP Trucos
Young diabetic patient with extense posterior fibrovascular proliferation and ERM. I performed phacovitrectomy in a myotic pupil. I ised a pupil dilation device (iRing) until the end of surgery. During vitrectomy I performed 360º peripheral vitreous truncation, complete vitrectomy and posterior membrane segmentation and delamination. I peeled ILM and performed vitreous shaving and PFC. During this video I give a few advices and tips and tricks I think are useful to success in this difficult procedure.
wonderful！
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Very nice thank you
What is the microscope and the wide field viewing system used?
Very nice job!
Another good one . Nice tips. Do laser on pattern to avoid boredom was nice ,?
Diego Ruiz Casas / VR Surgery Thanks again.
Thanks. Very rare cases in my country. I wish I could do more PDR cases, I really enjoy them.
Yes, PFC is quite bothersome, thus I try to find ways to make it more fun.
Thank you for your kind comments Ashish.
My good friends Ulrich Spandau and Zoran Tomic published an oustanding book about PDR vitrectomy. It focuses on every scenario and makes surgery logical and easier.
Diego
Oh great ! I will sure look for the book. Thanks 🙂
Situma PW
Peeling ends up being easy, delaminating membranes bimanually is always a challenge for everybody… specially when these cases are not that common currently.
Thanks
Very beautiful surgery.
Am currently a retina fellow and peeling the membranes has always been a challenge.
Do you do delamination using a wide angle lens or a flat lens? Surgery looks clean.. otherwise it bleeds a lot intraoperative for me..
Wide angle lens.
To reduce bleeding it is useful preop antivgef. Doing diathermy or pressure bleeding control as you delaminate is useful, i mean not leaving many oozing points without cautherizing them
Hola Diego, muchas gracias por tus videos, son de gran calidad y muy docentes. Estoy en mi 2ª año de formación de retina y me están sirviendo muchísimo. Sigue así. Me encantan !!!!!!!
Una pregunta; si crees que el pelado de la MLI es bueno en estos pacientes ?¿ No he encontrado mucha información al respecto. Hay estudios que revelan que no hay diferencias entre el pelado y el no pelado. Me gustaría si me pudieras decir tu opinión en base a tu experiencia. Mil gracias.
Es fundamental por lo siguiente:
1) es la mejor manera de ver si hay vitreosquisis posterior que puede arruinar la cirugía
2) suele haber algo de mer o ilm tensa que favorece el edema macular y pelando ilm lo tratas
3) evitas cualquier repriliferacion de de neovasos en ilm, que en casos extremos se ve
Únicamente en retinas muy isquémicas lo evito, parece que se deshace la retina al intentarlo.
Excellent surgery
Thank you for sharing
Are you favor or against combined phaco vitrectomy in diabetics
Do you strictly suggest us seperate surgery
Diego Ruiz Casas / VR Surgery
Thank you for answer
I do first phaco+anti vegf
One month later vitrectomy
yasar sakarya
This approach is similar to the reccomended by Dr Sapandau and Tomic. I think it might be the best option provided the PDR is not very severe and there is no risk of membrane contraction.
Thank you for your comment. Probably the best option phaco, then avgef 2-5d preppv, then ppv. But as I said, with new techniques and drugs, combining is safe.
Diego Ruiz Casas / VR Surgery
Yes
I read Ulrich Spandau’s book on
diabetic vitrectomy
I follow his comments
Thank you for kindly answer
yasar sakarya
Most diabetics have some degree of cataract, and faco makes vitreous surgery easier, so I think it is better to perform combined surgery. Whith modern surgery and antivgef the risk of iris neovascularization is very low, so there is no problem doing combined. However there is a higher risk of synechia. It might be a good approach doing phaco then avgef/pfc anf then ppv.
Amazingggg
5
q in try