Primary Retinal Detachment Research Articles

Rhegmatogenous retinal detachments: primary reattachment rates and visual outcomes over a 4-year period.

To describe rhegmatogenous retinal detachment surgery in a Dublin tertiary referral centre over a 4-year period and to examine factors predictive of surgical and anatomical success. A retrospective study was performed by reviewing the surgical log and the charts of patients who underwent a primary retinal detachment repair in a specialist centre over a 4-year period between 2012 and 2015. We excluded exudative and tractional cases. Multiple parameters were recorded including macular status, visual acuity, type of procedure, complications and visual and anatomical outcomes at 6months post operation. Primary reattachment rate was calculated alongside change in visual acuity. Chi-square testing and analysis of variance were utilized to determine the effect which lens status, macular status, extent of breaks and type of procedure had on outcome and visual success. A total of 613 primary rhegmatogenous retinal detachment repairs were performed over the 4-year period. Our primary reattachment rate was calculated to be 88.58% (annual range 85.25-91.30%) with a perioperative complication rate of 2.94%. We noted a statistical significant improvement in VA with a median logMAR VA of 1.0 at presentation to 0.5 at 6months post procedure. Macular status (chi-square test p = 0.15, X2 = 2.072) and lens status (chi-square test p = 0.2974, X2 = 1.086) had no statistical effect on the final anatomical outcome. However, eyes with giant retinal tears were more likely to redetach than those without (chi-square test p = 0.0069, X2 = 7.3). There was no statistical significant difference in the proportion of eyes achieving visual success by surgery category (one-way ANOVA analysis p = 0.501). This is the first study of its kind in Ireland and will help surgeons benchmark their results against international standards in the future. Accurate recording of logMAR acuity and intraoperative complications is imperative to assist with prospective studies.

PREDICTIVE FACTORS FOR PROLIFERATIVE VITREORETINOPATHY FORMATION AFTER UNCOMPLICATED PRIMARY RETINAL DETACHMENT REPAIR.

To determine predictive factors of proliferative vitreoretinopathy (PVR) formation after uncomplicated primary retinal detachment repair. Retrospective, single-center, case-control study of 74 consecutive patients with (37 eyes) and without (37 eyes) PVR formation after undergoing uncomplicated primary surgery for retinal detachment repair. Logistic regression was used to assess factors associated with PVR formation. Retinal detachment involving the macula was 4.2 times (adjusted odds ratio; 95% confidence interval, 1.4-12.9; P = 0.0119) more likely to have PVR formation compared with those without. Patients who were current or former smokers were 3.6 times (adjusted odds ratio; 95% confidence interval, 1.1-11.7; P = 0.0352) more likely to have PVR formation compared with nonsmokers. Compared with 25-gauge (g) vitrectomy, larger gauge vitrectomy (20 g or 23 g) was 3.6 times (adjusted odds ratio; 95% confidence interval, 1.2-11.3; P = 0.0276) more likely to have PVR formation. Duration of retinal detachment symptoms, high myopia, lens status, lattice degeneration, location of retinal break, number of retinal breaks, and surgical technique (e.g., scleral buckle with or without vitrectomy versus vitrectomy alone) were not found to be predictive of PVR formation. Cigarette smoking and macular involvement are significant risk factors predictive of PVR formation after uncomplicated primary retinal detachment repair.

Segmental scleral buckling without sling sutures around the muscles.

To introduce a modified technique for segmental buckling through a small in situ conjunctival opening without rectus muscle traction for minimally invasive repair of uncomplicated rhegmatogenous retinal detachment. This technique was performed in 15 eyes of 15 selected patients with primary retinal detachment. Conventional traction sutures placed beneath rectus muscles were replaced by an absorbable translimbal traction suture at lesion quadrant. The conjunctival incision was made 8-9 mm posterior and parallel to the limbus. After cryopexy, a minimal explant was fixed with one to two sutures through the conjunctival opening, expanded by a pediatric speculum. Retinal reattachments were achieved with correct buckle positions in all patients, with rapid cosmetic recovery. This modified buckling technique simplifies the buckling procedure, minimizes surgical invasiveness, preserves intact limbal conjunctiva, and relieves discomfort.

Трехмерная система визуализации «NGENUITY» в хирургии первичной регматогенной отслойки сетчатки

Трехмерная система визуализации «NGENUITY» в хирургии первичной регматогенной отслойки сетчатки

IMPACT OF INNER LIMITING MEMBRANE PEELING ON VISUAL RECOVERY AFTER VITRECTOMY FOR PRIMARY RHEGMATOGENOUS RETINAL DETACHMENT INVOLVING THE FOVEA.

To assess the impact of inner limiting membrane peeling during vitrectomy for macula-involving retinal detachment on best-corrected visual acuity (VA). Retrospective analysis of 89 eyes with primary macula-involving retinal detachment, which was undergoing vitrectomy, endolaser, retinotomy, endodrainage, and SF6 tamponade. Membrane-blue-assisted membrane peeling had been performed in 61 of the eyes (Group 1) but not in the other 28 (Group 2), which served as controls. Age, lens status, and incidence of proliferative vitreoretinopathy 26.2% versus 39.3%; P = 0.23 in the 2 groups were comparable. The preoperative visual acuity (Early Treatment Diabetic Retinopathy Study letters) was 25.7 ± 27.9 in Group 1 and 28.8 ± 29.9 in Group 2 (P = 0.47). After surgery, these rose from 62.3 ± 30.5 (Group 1) and 34.2 ± 35.8 (Group 2) after 1 week (P = 0.090), through 83.1 ± 8.0 and 57.2 ± 32.4 at 1 month (P = 0.0005), to 92.1 ± 4.5 and 74.4 ± 23.1 Early Treatment Diabetic Retinopathy Study letters after 6 months (P = 0.0005). More than 6-month incidences of proliferative vitreoretinopathy (13.1% vs. 28.6%; P = 0.13) were similar, whereas the redetachment rate (9.8% vs. 32.1%; P = 0.014), the incidence of secondary epiretinal membranes (1.6% vs. 35.7%; P = 0.0005), and the revitrectomy rate were lower in group 1 (9.8% vs. 53.6%; P = 0.0005). Inner limiting membrane peeling during vitrectomy for macula-involving retinal detachment may substantially contribute to the visual recovery, reducing the incidence of secondary epiretinal membrane formation.

A 21-Year Study of Vitreoretinal Surgery for Aphakic Retinal Detachment: Long-Term Surgical Outcomes and Complications

To determine the characteristics and outcomes of primary retinal detachment (RD) surgery in aphakic patients. Retrospective case series. Sixty eyes with primary aphakic RD (ARD) in 51 patients. A consecutive series of patients who underwent vitreoretinal surgery for primary rhegmatogenous ARD was analyzed retrospectively between 1997 and 2018 at Moorfields Eye Hospital. Best-corrected visual acuity (BCVA), surgical outcomes, and complications. Mean BCVA improved from 1.31 to 1.08 logarithm of the minimum angle of resolution (logMAR; P= 0.081) over a mean follow-up period of 8.2 years. Macula-off retinal detachments showed significantly improved BCVA from 1.72 to 1.1 logMAR (P= 0.007). Mean age was 38.8 years, and the most common cause of aphakia was congenital cataract surgery (55%). The macula was attached in 45% eyes, and grade C proliferative vitreoretinopathy (PVR) was present in 12%. Operations performed were vitrectomy (88%), combined vitrectomy and scleral buckle (8%), and encirclement (3%). The final anatomic success rate was 88%, and PVR was a significant predictor of redetachment (P= 0.03; odds ratio, 20.7; 95% confidence interval, 2.8-152.2). Raised intraocular pressure was the most common postoperative complication at 30%, with a rate of de novo postoperative glaucoma of 6.7% at final follow-up. We report high rates of primary and overall anatomic success for surgery in ARD surgery. Grade C PVR was a positive predictor for surgical failure. Final visual outcomes were limited by ocular comorbidity, and we report significant improved visual outcomes for macula-off ARD.

Biomarkers for PVR in rhegmatogenous retinal detachment.

PurposeVarious profibrotic and proinflammatory cytokines have been found upregulated in uncomplicated primary retinal detachment (pRD), but without providing a uniform picture. Here, we compare the cyto- and chemokine profiles in pRD with and without proliferative vitreoretinopathy (PVR) in an attempt to unravel relevant differences not in single cytokines, but in the cytokine profiles at diagnosis.MethodsUndiluted vitreous fluid (VF) was obtained at the beginning of surgery from 174 eyes with pRD without relevant PVR (maximally grade B; group 1; n = 81) and with moderate or advanced PVR requiring a gas tamponade (group 2; n = 49) or silicon oil filling (group 3; n = 44). VF of eyes undergoing macular hole (MH) surgery served as controls (group 4; n = 26). Forty-three cytokines were quantified in parallel using a multiplex cytokine analysis system (Bioplex). For all comparisons we applied Holm’s correction to control for multiple comparisons.Results44.9% of group 2 eyes presented grade C1 and 55.1% C2-C3, whereas 86.4% of group 3 eyes exhibited a PVR grade of C2-D.CCL19 was the only cytokine that displayed higher concentrations in the vitreous of eyes with PVR C1 compared to lower PVR grades. Eyes with PVR C2-D showed higher levels of CCL27, CXCL6, IL4, IL16, CXCL10, CCL8, CCL22, MIG/CXCL9, CCL15, CCL19, CCL 23 and CXCL12 compared to controls. Interestingly, no difference of cytokine levels was detected between C1 and C2-D PVR.ConclusionsCCL19 may represent a potential biomarker for early PVR progression that holds promise for future diagnostic and therapeutic applications.

Treatment of Localized Retinal Redetachment in Silicon Oil Filled Eyes

Purpose: To assess the success rate of retinal reattachment surgery in localized re-detachment in Silicon oil filled eyes which had previously undergone primary retinal detachment (RD) repair with pars plana vitrectomy (PPV) with silicon oil. Study Design: Retrospective cross sectional case series. Place and Duration: Farooq Hospital and Medicare eye centre, Lahore from October 2016 to November 2017. Material and Methods: All those patients were included in our study who underwent primary retinal attachment surgery with pars plana vitrectomy (PPV) and silicon oil for complicated retinal detachment as an internal tamponade and later presented with localized inferior retinal detachment within 6 months of previous RD repair. Patients with total detachment, extensive PVR, retinal shortening, gas tamponade, total Re RD, and external scleral buckle were excluded. Two ports were made under local anesthesia instead of three conventional ports, simple non irrigation vitrectomy technique was used to achieve retinal reattachment under silicon oil without exchange of SO. Results: Ten eyes of ten patients were included, eight (8) males and two (2) females. The age range was from 18 to 79 years. Most common cause of re detachment (RD) in all cases was proliferative retinopathy (PVR) followed by retinal break. The new retinal break was identifiable in three (3) cases. All cases attained anatomical success in term of complete retinal attachment after second operation in one year follow up period. Conclusion: Simple non irrigation vitrectomy surgical technique under local anesthesia is effective, economical and time saving as compared to complicated three port vitrectomy with oil exchange. Keywords: Silicon oil, rhegmatogenous retinal detachment, proliferative retinopathy, retinal break, Perflourocarbon.

The impact of duration on the recurrence of rhegmatogenous retinal detachment: optimal cutoff value.

To assess the impact of symptom duration on the recurrence of rhegmatogenous retinal detachment (RRD) and to determine the threshold symptom duration for recurrence. In this non-comparative, observational case series, a retrospective evaluation was made of the records of patients with RRD at baseline and during the postoperative follow-up period, in respect of postoperative anatomic outcome, prognostic factors for recurrent retinal detachment and the cutoff value of symptom duration. Recurrent retinal detachment was detected in 33 (17.8%) of 185 patients following primary retinal detachment surgery. The surgery type in phakic patients and preoperative symptom duration had a significantly high odds ratio for evidence of surgical failure. According to the ROC analysis, the threshold preoperative symptom duration was 20.5days. Our results showed that early reattachment surgery is necessary to lower the risk of retinal redetachment. The threshold at which RRD recurrence significantly increases is 20.5days.

Outcomes of Retinectomy in Rhegmatogenous Retinal Detachment with Proliferative Vitreoretinopathy

To evaluate the anatomical and functional outcomes of retinectomy in the management of primary rhegmatogenous retinal detachments with inferior retinal breaks and advanced proliferative vitreoretinopathy (PVR C). Quasi-experimental study. LRBT, Free Base Eye Hospital, Karachi, from July 2015 to June 2017. Forty eyes of 40 patients with primary inferior retinal breaks macula off detachments and advanced proliferative vitreoretinopathy (grade C) in which retinectomy was performed were included. Primary outcome measured was anatomic success, defined as complete retinal reattachment between neurosensory retina and retinal pigment epithelium at six months follow-up. Secondary outcomes included changes in best corrected visual acuity and postoperative complications. The follow-up period was up to six months after the last surgery. Association was determined between the retinectomy extension and the best corrected visual acuity postoperatively. Retina was reattached after single operation in 29 eyes (72.5%), after the second operation in eight eyes (20%), and after the third operation in two eyes (5%). Final retinal reattachment was achieved in 39 out of 40 eyes (97.5%). The preoperative visual acuity was counting fingers CF in eight eyes (20%), hand motion HM in 28 eyes (70%), and light perception PL in four eyes (10%). The postoperative visual acuity improved in 27 eyes (67.5%), remained stable in 11 eyes (27.5%), and worsened in 2 eyes (5%). There was no statistically significant association between the retinectomy extension and maximum postoperative best corrected visual acuity (p=0.098). The significant postoperative complications were retinal redetachment and hypotony. Retinectomies are effective in managing primary rhegmatogenous retinal detachment with severe PVR (PVR C), and Increase the final retinal reattachment rate.

Intraoperative OCT Features and Postoperative Ellipsoid Mapping in Primary Macula-Involving Retinal Detachments from the PIONEER Study

Intraoperative OCT (iOCT) has enabled visualization of subtle structural details during surgical interventions, including retinal detachment repair. The purpose of this study was to evaluate iOCT findings during retinal detachment repair and to assess their impact on anatomic and functional outcomes, including outer retinal integrity. The PIONEER Intraoperative and Perioperative OCT Study is a prospective cohort, institutional review board-approved study. Participants in the PIONEER undergoing surgical repair for primary macula-involving retinal detachment. This was a post hoc analysis of all eyes in the PIONEER undergoing surgical repair with primary macula-involving retinal detachments. Inclusion criteria included iOCT after perfluorocarbon liquid (PFO) placement, visualization of the foveal center on iOCT, and images of sufficient quality for quantitative assessment of submacular fluid volume. Exclusion criteria included recurrent retinal detachment, proliferative vitreoretinopathy, and a lack of postoperative OCT data after gas bubble resolution. Subretinal fluid volume on iOCT imaging was quantified. Qualitative review of iOCT images was performed for visualization of outer retinal bands, fluid, and retinal corrugations. Postoperative OCT images were analyzed using an ellipsoid zone (EZ) mapping platform to evaluate and quantify outer retinal metrics. Postoperative OCT images also were reviewed qualitatively for persistent subretinal fluid. Associations between various anatomic and functional outcomes were assessed. Presence of intraoperative subretinal fluid under PFO tamponade, postoperative persistent subretinal fluid, postoperative visual acuity at 1 year, and EZ integrity at 1 year. Fifteen eyes of 15 patients were analyzed. All 15 eyes (100%) showed subretinal fluid on iOCT. All eyes demonstrated spontaneous fluid resolution on follow-up OCT imaging. Increased intraoperative subretinal fluid volume under PFO tamponade trended toward significantly worse visual acuity outcome (P= 0.07). Postoperative quantitative EZ integrity at 12 months directly correlated with visual outcome (P= 0.01). Intraoperative subretinal fluid persists under PFO tamponade with high frequency in eyes undergoing retinal detachment repair, but this fluid does not seem to be associated with persistent postoperative subretinal fluid. Postoperative EZ integrity is associated with visual acuity outcome, and intraoperative subretinal fluid volume under PFO tamponade also may be linked to visual outcomes.

Success Rates for Retinal Detachment Repair in Alberta: A Physician Learning Program Initiative

Objective: To identify primary surgical success rates for retinal detachment repair in Alberta and compare functional outcomes of methods of repair. Methods: Data was retrospectively extracted from the Alberta Health Services Discharge Database and the National Ambulatory Care Reporting System for all patients diagnosed with retinal detachment and vitreoretinal procedures during the 2008/09 to 2012/13 fiscal years. Results: Of the 5,433 surgeries for retinal detachment identified, 279 were excluded due to invalid provincial health numbers, unidentified procedure location, and/or treating physician other than an Alberta retina surgeon. The final analysis included 4,336 detachments in 4,020 patients. The average primary retinal detachment success rate was 84.9% (3,680/4,336). Primary success rates varied between vitrectomy only (84.9%, 2,149/2,532), vitrectomy and scleral buckle (85.5%, 818/957), and scleral buckle (84.4%, 702/832). Conclusions: Alberta retina surgeons have an average primary success rate of 84.9% (3,680/4,336) for repair of retinal detachments. This result is in keeping with other published retinal detachment success rate studies.

Vitrectomy with silicone oil tamponade for retinal detachment associated with giant retinal tears: Favourable outcomes without adjuvant scleral buckling.

To evaluate the outcomes of pars plana vitrectomy with silicone oil tamponade in the management of retinal detachment associated with giant retinal tears. We reviewed 45 eyes of 42 patients with primary retinal detachment associated with giant retinal tears over 10years at a tertiary referral centre. Patients underwent 23-gauge vitrectomy without adjuvant scleral buckling by a single surgeon and had follow-up at least 6months after silicone oil removal. Mean follow-up was 37±35months. Seven eyes (16%) had grade C proliferative vitreoretinopathy, and 16 (36%) had a giant retinal tear ≥180° at baseline. The primary reattachment rate was 84%, and the overall final anatomical success rate was 98%. The mean Snellen visual acuity equivalent at the final visit was 20/58. Final visual acuity ≥20/40 was achieved in 64%. The mean duration of silicone oil tamponade was 10.5±4weeks. By the final visit, silicone oil had been removed from 44 eyes (98%). The high rates of anatomical and functional success support management of giant retinal tears-associated retinal detachment with vitrectomy without adjuvant scleral buckling. Removal of silicone oil at the earliest possible time helps to avoid complications such as keratopathy, glaucoma and visual loss without apparent reason.

Pneumatic Retinopexy Experience and Outcomes of Vitreoretinal Fellows in the United States: A Multicenter Study

To evaluate the outcomes of patients undergoing pneumatic retinopexy (PR) performed by vitreoretinal fellows at 6 academic centers in the United States. Retrospective, multicenter, consecutive case series. 483 patients with primary retinal detachments who underwent PR by 49 vitreoretinal fellows from 6 U.S. training sites between 2002 and 2016. We reviewed medical records of patients and recorded baseline clinical characteristics (age, sex, baseline visual acuity, lens status, presence of lattice degeneration, presence of vitreous hemorrhage, location of retinal breaks, macular status, and size of detachment), visual and anatomic outcomes at 3-months after PR, as well as training level and PR experience of the fellow at the time of the procedure. Single-procedure anatomic success and visual acuity at 3-months follow-up, and association with clinical and training-related factors. Vitreoretinal fellows performed a variable number of PR, with a median of 7 cases per fellow (range 1-24). Single-procedure anatomic success was 66.8%, and mean LogMAR visual outcome was 0.43 (Snellen equivalent 20/54) at 3 months. Factors that were independently associated with single-procedure success include phakic lens status (P = 0.01), smaller size of retinal detachment (P = 0.02), and the fellow's procedure experience (P = 0.01). The only factor associated with worse visual outcome was baseline visual acuity (P < 0.001). Vitreoretinal fellows perform variably few pneumatic retinopexies but have outcomes comparable to reported rates by experienced specialists. Procedure experience of individual fellows may impact anatomic outcomes.

Repair of Primary Retinal Detachment: Review of Techniques for Repair Developed in the Past 85 Years

Repair of Primary Retinal Detachment: Review of Techniques for Repair Developed in the Past 85 Years

Comparison of 25- and 27-Gauge Pars Plana Vitrectomy in Repairing Primary Rhegmatogenous Retinal Detachment.

Aim To compare the anatomic and visual outcomes of 25-gauge (25G), and 27-gauge (27G) transconjunctival sutureless pars plana vitrectomy (TSV) for the management of primary rhegmatogeneous retinal detachment (RRD). Design A retrospective nonrandomized clinical trial. Methods A retrospective comparative analysis of 62 consecutive eyes from 62 patients with 6 months of follow-up was performed. Results Thirty-two patients underwent 25G TSV, and 30 patients underwent 27G TSV for the treatment of primary RRD. There was no significant difference in baseline demographic and preoperative ocular characteristics between the two groups. The initial and final anatomical success rates were 93.8% and 100% in 25G TSV and 96.7% and 100% in 27G TSV, respectively (p=1 and p=1, resp.). Preoperative best-corrected visual acuity (BCVA) (logMAR) was 0.44 ± 0.69 and 0.38 ± 0.61 for 25G and 27G TSV, respectively (p=0.73). The final follow-up BCVA was 0.07 ± 0.25 and −0.02 ± 0.17 for 25G and 27G TSV, respectively (p=0.16). The final BCVA was significantly better than the preoperative BCVA in both groups (p=0.02 and p=0.002, resp.). Preoperative intraocular pressure (IOP) (mmHg) was 13.0 ± 3.5 in 25G TSV and 14.3 ± 2.8 in 27G TSV (p=0.11). IOP did not statistically significantly change in both groups during the follow-up period (p=0.63 and p=0.21, resp.). Conclusion The 27G TSV system is safe and useful for RRD treatment as 25G TSV.

The Outcomes of Primary Retinal Detachment Surgery with 23-gauge Vitrectomy in Patients without Severe Proliferative Vitreoretinopathy: A Single Surgeon Case Series

The Outcomes of Primary Retinal Detachment Surgery with 23-gauge Vitrectomy in Patients without Severe Proliferative Vitreoretinopathy: A Single Surgeon Case Series

Internal Limiting Membrane Peeling in Macula-off Retinal Detachment Complicated by Grade B Proliferative Vitreoretinopathy

To investigate the clinical benefit of internal limiting membrane (ILM) peeling as a surgical adjunct in the repair of primary retinal detachment (RD) complicated by grade B proliferative vitreoretinopathy (PVR). Retrospective, interventional, comparative case series. Setting, study population, observationalprocedures and Main outcome measures. Institutional. Seventy-five consecutive patients who underwent vitrectomy for primary macula-off RD complicated by grade B PVR. Patients were divided into an ILM peeling (Group P) and a no ILM peeling group (Group NP). Anatomic success rate, best-corrected visual acuity, and spectral-domain optical coherence tomography (SD-OCT) characteristics were collected at 1 and 6months. In all, 37 eyes with ILM peeling were included in Group P and 38 eyes without ILM peeling were included in Group NP. The anatomic success rate after single surgery was higher in Group P (89%) than in Group NP (66%, P= .03). Mean final visual acuity was 0.41 ± 0.40 logMAR in Group P vs 0.43 ± 0.22 logMAR in Group NP (P= .82). We found no epiretinal membrane (ERM) formation in Group P, whereas 5 cases of ERM (20%) were detected in Group NP (P= .012). The 2 groups did not differ in terms of cystoid macular edema occurrence, macular thickness, or photoreceptor damage. ILM peeling during vitrectomy in macula-off RD complicated by grade B PVR reduces the need for a second surgery for redetachment or macular pucker.

Sutureless Belt Loops versus Sutured Buckle Technique in Combination with Vitrectomy for Retinal Detachment Repair: A Comparative Analysis

Objective: To compare the anatomic and visual outcomes in primary rhegmatogenous retinal detachment repair involving combined pars plana vitrectomy (PPV)/scleral buckle (SB) using a sutureless belt loops technique versus a conventional sutured buckle technique. Methods: This is a retrospective, consecutive, interventional, comparative case series study using patients treated for primary retinal detachment who underwent the SB procedure in combination with PPV. Details regarding anatomic and visual outcome were analyzed. Results: Thirty-five eyes were included in this study: 18 eyes (18 patients) treated with combined PPV and SB performed using a sutureless belt loops technique (group A) and 17 eyes (17 patients) treated with combined PPV and SB sutured to the sclera (group B). Successful anatomic attachment and appropriate buckle height were achieved in all 35 cases. There was 1 case of redetachment in each group during the follow-up: 1/17 (5.9%) in group A and 1/18 (5.6%) in group B (p = 0.97). No cases of buckle infection, extrusion, or intrusion were noted during the follow-up period. Conclusion: SBs installed using a belt loops sutureless technique appear to be as safe and effective as those applied using conventional suturing for repair of retinal detachment, with similar anatomic and functional outcomes.

Double-infusion cannula technique for glued fixation of intraocular lens with endothelial keratoplasty

ObjectiveTo describe double-infusion cannula technique (DICT) that involves the placement of 2 infusion cannulas in a combined surgical approach of glued intrascleral haptic fixation of intraocular lens (glued IOL) with endothelial keratoplasty (EK) in patients with aphakic bullous keratopathy. DesignProspective, single-centre, interventional study. ParticipantsFive eyes of 5 patients. MethodsThe first cannula placed for fluid infusion at pars plana stabilises the globe and facilitates vitrectomy with the glued IOL procedure. Secondary IOL fixation compartmentalises the eye into anterior and posterior chamber and a continuous posterior fluid infusion prevents globe collapse in an already vitrectomized eye. The second cannula is placed at the level of limbus for pressurised air infusion that facilitates an EK procedure. When the donor graft is being unfolded, air infusion is stopped and fluid from the posterior infusion pushes up the iris IOL diaphragm and facilitates graft unfolding. ResultsThe mean follow-up was 14 ± 5 months (range 9–21 months). The donor age ranged from 35–57 years, and the mean percentage of endothelial cell loss calculated at 9 months follow-up was 27.32% ± 3.65%. The mean preoperative and postoperative best-corrected visual acuity was 1.02 ± 0.164 and 0.276 ± 0.173 logMAR, respectively (p = 0.000). No incidence of primary graft failure, graft rejection, or retinal detachment was reported during the entire follow-up period in any of the eyes. ConclusionDICT prevents hypotony and intraoperative pressure fluctuations, assists graft unrolling, promotes adherence to the recipient bed tissue, and prevents seepage of air into the vitreous cavity and loss of air tamponade in the anterior chamber.