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Preoperatively, the
patient received 3 doses each of cyclopentolate 1% and tropicamide
1% every 5 minutes over a 15-minute period. The
patient underwent surgery OD under general anesthesia. She
was sedated with Fentanyl, Diprivan, Lidocaine, Zemuron, and Desflurane
gas. Intraoperatively, the
patient received supplemental oxygen via face mask at 4 L/min
with an FIO2 ranging
from 50% to 100% and an SpO2
of 100% throughout the surgery. Her blood pressure was 148/90
mm Hg preoperatively and ranged from 150/80 to 100/50 mm Hg during
the surgery. Postoperatively, her blood pressure was 121/62 mm
Hg. The hematocrit was 38%, and hemoglobin electrophoresis revealed
HbS 59%, HbC 41%, with no detectable HbA.
Because of known SC disease, the patient underwent an uncomplicated
3-port pars plana vitrectomy rather than scleral buckling surgery
to repair the retinal detachment.
SURGICAL
TECHNIQUE: The
conjunctiva was incised clockwise from the 6-o’clock to the
2-o’clock position, and a 3-mm infusion cannula was introduced
through a sclerotomy 4 mm posterior to the limbus at the 8-o’clock
position. No muscles were isolated. A posterior vitreous detachment
was noted intraoperatively, which facilitated removal of the central
vitreous gel. Extensive peripheral vitreous
dissection was performed to relieve traction anterior to
the neovascularization and the anterior margins of the retinal tears.
Diathermy was used to create a drainage
retinotomy outside the superotemporal arcade in the 10-o’clock
meridian, and a fluid-gas exchange was performed to reattach the
retina. Laser photocoagulation was
applied around the drainage retinotomy, around the peripheral retinal
breaks, behind the sclerotomies, and in the periphery to surround
areas of neovascularization. Approximately 300 degrees of the periphery
was treated. The vitreous cavity was then flushed with 20% SF6
gas, and the closing intraocular pressure was measured at 8 with
a 5.5 g weight using a Schiotz tonometer. Subconjunctival injections
of cefazolin (100 mg/0.5 ml) and Decadron® (4 mg/0.5 ml) were
administered as well as topical dorzolamide, timolol and TobraDex®
ointment. The procedure was completed (time from initiation of surgery
to patient leaving the operating room) in 1 hour and 40 minutes. |
