DR.YUSRA ASAD

Dr. LALIT VERMA, Dr. AVNINDRA GUPTA

Abstract

A 49 years old male presented to our outpatient department with dimunition of vision in his right eye for 6 months duration. Left eye examination was unremarkable. Right eye examination revealed evidence of anterior uveitis (posterior synechiae, pigment on surface of an early cataractous lens, small irregular pupil, 2+ flare) . His BCVA was 6/60 in the right eye and 6/6 in his left eye. Indirect Ophthalmoscopy revealed a predominantly nasal retinal detachment in his right eye for which a vitreoretinal surgery was planned. On the operating table, 23 gauge pars plana ports were made with confirmation of intravitreal position of the infusion cannula. But on starting vitrectomy , it was realised that the retinal detachment had become a total bullous detachment with bullae just behind lens and subretinal endolight cannula at 2 O’clock. The endolight port was then shifted to 12 o’clock and surgery continued with lot of difficulty navigating between the retinal bullae. PFCL was injected and membrane dissection continued as far as possible with the absurd placement of ports. Further, upon attempting to settle the retina with an air fluid exchange, it was realised that the infusion port had gone subretinal as well with air filling up subretinally. The infusion port was then shifted. Subretinal air was evacuated with help of active suction with back flush needle. Finally air fluid drainage was done followed by silicone oil injection. The multiple breaks present from before and some made iatrogenically were then lasered along with periphery retinal ablation. 1 week Postoperatively patient has a settled retina with BCVA of 6/60. The presentation shall highlight the nightmare problems faced and suggest measures as to how to wriggle out of it !