Augmentation of Local Anesthesia During Retinal Detachment Surgery

• Because the effect of local anesthesia from a retrobulbar injection diminishes with time, local anesthesia during prolonged retinal surgery may be difficult. A simple, safe, and effective technique for administration of supplemental intraoperative local anesthesia during retinal detachment surgery is described. After a limbal peritomy is performed and the quadrants are dissected bluntly, a 19-gauge irrigating cannula is passed posterior to the globe to irrigate the recti muscles and the retrobulbar space with 4% lidocaine hydrochloride. Using this technique, even prolonged vitreoretinal surgery can be performed using local anesthesia with minimal patient discomfort

Recognition and Removal of the Posterior Cortical Vitreous During Vitreoretinal Surgery for Impending Macular Hole

Vitreoretinal surgery for impending macular hole includes recognition and removal of the posterior cortical vitreous. Previously described surgical techniques for removal of cortical vitreous used either rigid instruments (a tapered extrusion needle or a barbed microvitreoretinal blade) or a short fenestrated soft-tipped suction needle. We used a technique with the cannulated extrusion needle that detects the presence of the posterior cortical vitreous and facilitates safe removal of this layer from the retina. Although this technique is most useful when performing vitrectomy for impending macular hole, it may also be used during vitrectomy for other conditions with uncertain detachment of the posterior cortical vitreous

Pneumatic vitreolysis for management of symptomatic focal vitreomacular traction

Pneumatic vitreolysis (PVL) is the intravitreal injection of a small quantity of expansile gas for the purpose of achieving focal vitreomacular traction (VMT) release for eyes with symptomatic VMT, or inducing VMT release and closure of the macular defect for eyes with a small stage-2 macular hole (MH). Initially, there was limited interest in this technique upon its introduction for clinical treatment in human eyes in 1993. With the advent of optical coherence tomography allowing detailed observation of vitreomacular interface changes and rising importance of medical economics in recent years, there has been increasing interest in PVL, a low-cost procedure for managing symptomatic VMT. The success rates of VMT release in the literature have ranged from 60% to 100% and the rates of closure of small macular holes have ranged from 50% to 80% following PVL. In a recent retrospective consecutive series of 56 eyes in two centers undergoing C3F8 gas injection, Chan and Mein reported an overall success of 86% in VMT release and 60% closure of small macular holes with few adverse events (7% with retinal breaks, retinal detachment, or progression of VMT). Multiple recent studies have shown superior outcome utilizing C3F8 gas compared with SF6 gas for PVL. In conclusion, PVL is a promising, low-cost therapeutic option, with the potential for managing symptomatic focal VMT on a global scale

Stellate Multiform Amelanotic Choroidopathy (SMACH). Clinical and Multimodal Imaging Features

PURPOSE: To describe the clinical and multimodal imaging features of stellate multiform amelanotic choroidopathy (SMACH; also known as serous maculopathy due to aspecific choroidopathy). METHODS: Retrospective observational case series of eyes presenting with SMACH. Multimodal imaging including fundus photography, optical coherence tomography (OCT), OCT-angiography (OCTA), and indocyanine green angiography (ICGA) was analyzed. RESULTS: Eighteen eyes from 18 patients (mean age: 28±19 years) were included. The mean follow-up duration was 9 years. Ophthalmoscopy showed a yellowish-orange, dendriform choroidal lesion. At presentation, subretinal fluid (SRF) was seen in 10/18 cases (56%). Eight patients (44%) showed no evidence of SRF during a mean follow-up of 6 years. Cross-sectional OCT showed hyperreflective fibrous-like changes within the inner choroid with choriocapillaris flow preservation on OCTA. En face OCT showed a hyperreflective choroidal lesion with finger-like projections oriented in a stellate configuration. On ICGA, SMACH showed early and late hypofluorescence. None of the cases showed lesion growth. CONCLUSIONS: SMACH appears to be a unilateral choroidopathy characterized by distinctive multimodal imaging features. As SRF was absent in some cases, while a dendriform pattern was a consistent finding in all eyes, we propose renaming this entity stellate multiform amelanotic choroidopathy , a name which retains its prior abbreviation SMACH