Visualizing the obscure- Chromophore-assisted retinal break detection.

Abstract

Finding a retinal break which is responsible for retinal detachment is a critical step in the surgical treatment of this condition. In spite of improvement in visualization systems in pars plana vitrectomy, identifying the break which is the source of subretinal fluid (SRF) could pose a challenge, especially in complex retinal detachments or re-detachments with extensive laser scars. The current technique of break identification involves direct detection of the break via peripheral indentation or using perfluorocarbon liquid (PFCL) to displace SRF from the posterior retina to the periphery and visualizing the proteinaceous SRF egress from the retinal break. In retinal detachments, if no peripheral breaks are visualized, surgeons tend to make a posterior draining retinotomy and drain SRF, the necessity of which can be confirmed after subretinal brilliant blue green (BBG) dye injection. In addition, in already vitrectomized eyes where it can be difficult to identify SRF egressing via the break, subretinal BBG dye provides a color contrast that enhances break visualization. A method to identify these occult breaks was required, which is described in this video. Hence, the idea of BBG dye injection into the subretinal space with a 41G subretinal needle was thought of. PFCL would be placed over the posterior pole, which would displace the dye to the periphery, and this would disperse out into the vitreous cavity into a blue plume via the break, thereby leading to its identification. Subretinal dye injection is useful for occult retinal break detection as it provides a color contrast. A posterior draining retinotomy can be avoided. It is also useful in recurrent retinal detachments. We describe the use of BBG, which is the least toxic dye available, and report the use of this technique in Indian eyes. https://youtu.be/JGXQjNV9asw.