In-office procedures for complications after vitreoretinal surgeries can be time and cost-efficient and can avoid a reoperation. Some of the complications that can be treated in-office include recurrent vitreous hemorrhage, gas complications, retained perfluorocarbon liquids, and complications associated with silicone oil.
For mild hemorrhages in pseudophakic eyes an ND:YAG peripheral capsulotomy can be performed, opening both the anterior and posterior capsules peripheral to the edge of the IOL. This allows red blood cells to pass into the anterior chamber and clear through the trabecular meshwork. The technique involves dilation of the eye, then treating one or two areas around the intra-ocular lens optic, creating an opening of 2-3 mm.
For recurrent dense hemorrhages, or hemorrhages in either phakic or pseudophakic eyes. The single syringe approach is described below.
If inadequate gas fill is noted in the post-op period after vitrectomy (in the form of a small bubble), the same technique described above of fluid-air exchange is used, except instead of air, a filtered gas mixture is utilized. Injecting 0.9 cc(mL) of pure gas through the pars plana can also be performed, with withdrawal of gas to keep the intraocular pressure (IOP) in the normal range.
If excessive gas is noted post-op, with elevated IOP and a shallow anterior chamber, removal of 0.9cc(ml) of intravitreal gas can be performed through the pars plana with a syringe and a 30-gauge needle.
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Westmead Eye Manual
This invaluable open-source textbook for eye care professionals summarises the steps ophthalmologists need to perform when examining a patient.