Tying forceps

Depressor

Wescott

Lid Retractor

Tenotomy Scissors

Needle Holder

Caliper

0.3 Forceps

Instruments used for Vitrectomy Procedure

Conjuctiva Forceps

Landers Vitrectomy Lenses (30 degree angle lens, plano lens)

Flute

Landers Lens Ring

Vitrectomy Machine

Vitrectomy instrument, Fiberoptic light

Barroga, Marilyn Richelle R. Macrohon, Stephen Dave NPG-2 Patients Profile:

CI: Maam Dispo

Domantay, Rizalino a resident of Cayanga San Fabian Pangasinan and a 44 year old married Filipino male patient. Patients attending physician is Dr. Santiago and surgeon as well with the help of Doctor Fernandez. he was admitted last august 15,2010 and was in an NPO status until before the surgery, but was in DAT diet after his operation. History: A history of Curtain like BOV OS was written on the patients chart. He also claimed that he felt a slight feeling of heaviness in his left eyen and with sudden blurring of his vision. Pathophysiology of Rhegmatogenous Retinal Detachment Vitreoretinal traction is responsible for the occurrence of most RRD. As the vitreous becomes more syneretic (liquefied) with age, a posterior vitreous detachment (PVD) occurs. In most eyes, the vitreous gel separates from the retina without any sequelae. However, in certain eyes, strong vitreoretinal adhesions are present and the occurrence of a PVD can lead to a retinal tear formation; then, fluid from the liquefied vitreous can seep under the tear, leading to a retinal detachment. A number of conditions exist that predispose to a PVD by prematurely accelerating the liquefaction of the vitreous gel. Myopia, aphakia or pseudophakia, familial conditions, and inflammation are among the common causes. In other cases, retinal necrosis with a retinal break formation occurs; then, fluid from the vitreous cavity can flow through the breaks and detach the retina without there being overt vitreoretinal traction present. *Retinal detachment is a disorder of the eye in which the retina peels away from its underlying layer of support tissue. Initial detachment may be localized, but without rapid treatment the entire retina may detach, leading to vision loss and blindness. It is a medical emergency. *Rhegmatogenous retinal detachment A rhegmatogenous retinal detachment occurs due to a hole, tear, or break in the retina that allows fluid to pass from the vitreous space into the subretinal space between the sensory retina and the retinal pigment epithelium Procedure: August 16, 2010 at 8:50 in the morning, patient Rizalino Domantay entered the Operating room per wheelchair and ambulatory accompanied by the Nurse On Duty with an ongoing IVF of D5LRS 1Liter at 750 cc level. With consent signed attached to his

chart. His vital signs were taken before the procedure starts, a BP of 153/83, HR of 63, RR of 21 and SpO2 of 99. He was positioned in a supine position and was draped by the assisting nurse on his left eye. At exactly 9:00 am Dr. Santiago inducted a local anesthesia on the Left eye in preparation for the operation, his arm straps are applied as well. 9:15 am the operation started led by Dr. Santiago and was assisted by Dr. Fernandez, peritomy and hestatin done as well as vitrectomy (a surgery to remove some or all of the vitreous humor from the eye) at 750 cpm, 250 mmhg. The initial step in this procedure is usually the removal of the vitreous gel through very small (1.4mm) incisions in the eye wall, hence the name "vitrectomy". The vitreous is removed with a miniature handheld cutting device and replaced with a special saline solution similar to the liquid being removed from the patients left eye. A high intensity fiber optic light source was used to illuminate the inside of the eye. The surgeons used a specialized operating microscope with the help of Landers lenses (during the operation Dr. Santiago used plano lens and the 30 degree angle lens), which allow a clear view of the vitreous cavity and retina at various magnifications. After the vitrectomy, Dr. Santiago performed Retinotomy at 11:00 position (a retinal incision through the retina). Then he performed air fluid exchange (injection of air into the eye to remove the intraocular fluid from the Posterior Segment of the globe while maintaining IntraOcular Pressure to temporarily hold the retina in place or seal off holes in the retina. The air pressure is temporary as the Posterior Segment will soon re-fill with fluid.), after the air-fluid exchange Endolaser power 300 shots 200 was performed (A quartz fiber is used to direct the laser energy to the target area for the incision, division or resection of tissue.) At 10:00 am the parts are closed and Silicon Oil (Arciolane 200cs at 7.0 cc) was injected (used instead of gas to keep the retina attached postoperatively. Silicone remains in the eye until it is removed (often necessitating a second surgery at a later date). This technique is advantageous when long term support ("tamponade") of the retina is required, for instance in the repair of very complicated retinal detachments. Unlike gas, patients are still able to see through clear silicone oil. Positioning is less critical with silicone oil, therefore, it may be used in patients unable to position postoperatively (i.e. children). Like gas, silicone oil can promote cataracts, cause glaucoma, and may damage the cornea.) 10:15 am parts of the conjuctiva was closed and the operation was ended. At 10:25am the patient was fully conscious and transeferred into the PACU for recovery with an IVF of D5LRS at 650cc level in a prone position. The patient is in DAT diet and was advised to position himself facedown for 1 week. at exactly 12:00 noon the patient was back to the ward and was endorsed for further care and management.