Not-so-minimal for minimally invasive surgery

Indian J Ophthalmol. 2022 Feb;70(2):665-666. doi: 10.4103/ijo.IJO_1726_21.

Abstract

Sub-macular hemorrhage poses a potential threat to vision if left untreated. The preferred surgical technique to clear sub-macular hemorrhage includes vitrectomy followed by retinotomy using a 41G needle with subsequent injection of recombinant tissue plasminogen activator (r-tPA) followed by air/SF6 injection into the sub-retinal space. A malleable nature, increased resistance, and the cost of the 41G needle limit its use. We evaluated the safety and efficacy of a 26G needle for retinotomy as a supplement for the 41G needle in a series of six subjects with sub-macular hemorrhage. A slight modification in the procedure was done by injecting air into the sub-retinal space prior to the r-tPA injection. We found that our technique of using the 26G needle for retinotomy is safe and effective due to its stable nature and self-sealing properties. An air injection prior to r-tPA allows for increased bioavailability of the drug by preventing efflux due to its tamponading effect.

Keywords: 26G needle; recombinant tissue plasminogen activator (r-tPA); retinotomy; sub-macular hemorrhage.

MeSH terms

  • Fibrinolytic Agents
  • Humans
  • Macular Degeneration* / drug therapy
  • Minimally Invasive Surgical Procedures
  • Retinal Hemorrhage / diagnosis
  • Retinal Hemorrhage / drug therapy
  • Retinal Hemorrhage / surgery
  • Retrospective Studies
  • Tissue Plasminogen Activator*
  • Visual Acuity
  • Vitrectomy / methods

Substances

  • Fibrinolytic Agents
  • Tissue Plasminogen Activator