Kisha
Networker
Pars plana vitrectomy with membrane lysis, endolaser,
perfluorocarbon, silicone oil and pars plana lensectomy,
left eye.
I HAVE 67040, 67041, 66850, 66020, 67113
ANESTHESIA: General endotracheal.
OPERATIVE PROCEDURE: The patient was identified and the procedure verified in
The preoperative holding area. The patient was brought to the operating room, and the anesthesia
department administered general endotracheal anesthesia. The left eye was prepped and draped in the
usual sterile manner for intraoperative surgery. Betadine was placed in the fornices, and lid speculum
was applied to the left eye. A temporal limbal peritomy was made from 2 to 4 o’clock. A nasal limbal
peritomy was then made from 9 to 10 o’clock. Hemostasis was achieved with wet-field cautery. The
sclerotomy sites were marked 3.75 mm from the limbus at the 10, 2 and 4 o’clock positions. A 6-0 Vicryl
was placed around the 4 o’clock sclerotomy. The MVR blade was used to make the 4’oclock sclerotomy.
The infusion cannula was placed into the eye and tied on a slip knot. Under direct visualization the
infusion was found to be in good position and turned on. The 2 o’clock sclerotomy was made with the
MVR blade. The vitrectomy handpiece was inserted with a cut rate of 200 and a suction of 200. A pars
plana lensectomy was performed, the majority of the nucleus dislocated posteriorly. The MVR blade was
used to make the 10 using scleral depression. The lens material was trimmed to the ciliary body of 36°.
Using the Biome viewing system, light pipe and fragmatome, the lens material that dislocated
posteriorly was engaged and phacoemulsified removing all of the lens material. Using a combination of
the lighted pick, diamond-dusted intraocular forceps, and the tented diamond-dusted soft tip, the
membranes from the retinal surface were stripped and trimmed to the vitreous base. The traction over
the vitreous base was varied here and difficult to dissect. There were several breaks over the vitreous
base inferiorly and nasally and a small one temporally as well. It was felt that the retina would not
reattach without a retinotomy one temporally as well. These areas were connected. A retinotmy was
made at the vitreous base for approximately 250° degrees. In the superior area, there was no
retinotomy, perfluorocarbon was injected flattening the retina nicely over the buckle. Endolaser was
applied for 360° to the edge of the retina in a panretinal photocoagulation fashion. The soft tip
extrusion cannula was used to perform an air fluid exchange followed by an air perfluorocabon
exchange. The retina was nice and flat. The vitrectomy handpiece was used to perform an inferior
surgical iridectomy. Scleral plugs were placed as the oil was prepared. The soft tip was reintroduced
removing the remaining fluid from the retinal surface. The cannula with oil introduced, and oil was
injected to the level of the sclerotomy. The sclerotomy was closed with 7-0 Vicryl. The slip knot on the
infusion cannula was loosened. The assistant pulled the cannular and the surgeon pulled the knot
closing the final sclerotomy. Pressure was felt to be approximately 15. The conjunctiva was closed with
6-0 plain suture. Subconjunctival injections of Vancomycin and Dexamethasone were given inferiorly.
Topical solution of Pred Foret, Atrophine, and Timoptic were applied to the surface of the eye. A light
patch and shield was applied. The patient left the operating room in good condition ha
perfluorocarbon, silicone oil and pars plana lensectomy,
left eye.
I HAVE 67040, 67041, 66850, 66020, 67113
ANESTHESIA: General endotracheal.
OPERATIVE PROCEDURE: The patient was identified and the procedure verified in
The preoperative holding area. The patient was brought to the operating room, and the anesthesia
department administered general endotracheal anesthesia. The left eye was prepped and draped in the
usual sterile manner for intraoperative surgery. Betadine was placed in the fornices, and lid speculum
was applied to the left eye. A temporal limbal peritomy was made from 2 to 4 o’clock. A nasal limbal
peritomy was then made from 9 to 10 o’clock. Hemostasis was achieved with wet-field cautery. The
sclerotomy sites were marked 3.75 mm from the limbus at the 10, 2 and 4 o’clock positions. A 6-0 Vicryl
was placed around the 4 o’clock sclerotomy. The MVR blade was used to make the 4’oclock sclerotomy.
The infusion cannula was placed into the eye and tied on a slip knot. Under direct visualization the
infusion was found to be in good position and turned on. The 2 o’clock sclerotomy was made with the
MVR blade. The vitrectomy handpiece was inserted with a cut rate of 200 and a suction of 200. A pars
plana lensectomy was performed, the majority of the nucleus dislocated posteriorly. The MVR blade was
used to make the 10 using scleral depression. The lens material was trimmed to the ciliary body of 36°.
Using the Biome viewing system, light pipe and fragmatome, the lens material that dislocated
posteriorly was engaged and phacoemulsified removing all of the lens material. Using a combination of
the lighted pick, diamond-dusted intraocular forceps, and the tented diamond-dusted soft tip, the
membranes from the retinal surface were stripped and trimmed to the vitreous base. The traction over
the vitreous base was varied here and difficult to dissect. There were several breaks over the vitreous
base inferiorly and nasally and a small one temporally as well. It was felt that the retina would not
reattach without a retinotomy one temporally as well. These areas were connected. A retinotmy was
made at the vitreous base for approximately 250° degrees. In the superior area, there was no
retinotomy, perfluorocarbon was injected flattening the retina nicely over the buckle. Endolaser was
applied for 360° to the edge of the retina in a panretinal photocoagulation fashion. The soft tip
extrusion cannula was used to perform an air fluid exchange followed by an air perfluorocabon
exchange. The retina was nice and flat. The vitrectomy handpiece was used to perform an inferior
surgical iridectomy. Scleral plugs were placed as the oil was prepared. The soft tip was reintroduced
removing the remaining fluid from the retinal surface. The cannula with oil introduced, and oil was
injected to the level of the sclerotomy. The sclerotomy was closed with 7-0 Vicryl. The slip knot on the
infusion cannula was loosened. The assistant pulled the cannular and the surgeon pulled the knot
closing the final sclerotomy. Pressure was felt to be approximately 15. The conjunctiva was closed with
6-0 plain suture. Subconjunctival injections of Vancomycin and Dexamethasone were given inferiorly.
Topical solution of Pred Foret, Atrophine, and Timoptic were applied to the surface of the eye. A light
patch and shield was applied. The patient left the operating room in good condition ha