Maria H. Berrocal
KOLOA, Hawaii — When faced with a case of diabetic retinal detachment, successful management can be improved by optimizing visibility, controlling intraoperative hemorrhages, preventing iatrogenic breaks, preventing and managing postoperative bleeding, and recognizing and managing re-detachment early, according to a presentation at Retina 2020.
Wide angle viewing systems are very useful for visualizing the retinal periphery, with 3D viewing providing increased magnification, enhanced depth of focus and an optimal view under air, Maria H. Berrocal, MD, said.
“I like using a chandelier, particularly in tractional and rhegmatogenous retinal detachment,” she said.
To control hemorrhage, Berrocal uses Avastin (bevacizumab, Genentech) 1 to 5 days preoperatively as well as panretinal photocoagulation, if possible.
Intraoperatively, Berrocal stays aware of the patient’s blood pressure.
“Many of these patients have very high blood pressure,” she said. “I talk to the anesthesiologist throughout the case to make sure the pressure is controlled.”
Intraoperatively, Berrocal said she uses the smallest gauge probe possible, 27 gauge, because bleeding is less both during and after surgery.
“Complete removal of the hyaloid is key,” she said. “I use valved cannulas, and diathermy, laser or pressure on the vessels can control bleeding during the case.”
To prevent iatrogenic breaks, Berrocal said she likes to use a lift and shave technique in which she alternately separates tissue by lifting with aspiration using the vitrectomy probe and then shaves the separated tissue. If an iatrogenic break is created, she marks the break with diathermy and removes all traction. By peeling the tissue with the probe on aspiration, excessive traction that would be caused by forceps is avoided, she said.
Another technique she prefers and performs about once every 2 weeks in her office to manage postoperative bleeding is a fluid-air exchange.
“This avoids having to reoperate a lot of patients,” she said.
Finally, recognizing re-detachment early and determining the cause so they can be managed is important, she said. – by Patricia Nale, ELS
Reference: Berrocal MH. Pearls of diabetic retinal detachment management. Presented at: Retina 2020; Jan. 19-24, 2020; Koloa, Hawaii.
Disclosure: Berrocal reports she is a speaker or consultant for Alcon, Allergan and Quantel.