MEDICAL ASSESMENT: The patient is a 55-year-old female with a history of lost vision in her left eye. Beginning several weeks ago, she noticed the visual field defect over several days and was found to have a nasal retinal detachment in the left eye. The recommendation was made for a scleral buckle to repair the retina. The risks include pain, bleeding, infection, loss of vision, blindness, cataract, glaucoma, recurrent retinal detachment, scar tissue, and need for further operation or procedure.
The patient has plans to travel by plane in less than one week and was very insistent on not using the gas bubble if possible in order to allow travel. The patient understood all the risks and elected to proceed.
DESCRIPTION OF PROCEDURE: On…show more content… 5 x 3. She was brought from the holding area to the operating suite where appropriate monitors were placed, followed by administration of anesthesia and general endotracheal anesthesia was induced. The right eye was taped shut and a shield placed over it for protection. The left eye was prepped and draped in the usual sterile fashion. The blunt Westcot scissors were used to create a 360 degree conjunctival peritomy. Then, the curved Stevens scissors were used to dissect into each of the four quadrants into the sub-Tenon space. A muscle hook was used to isolate each of the 4 rectus muscles and 2-0 silk tie was then swung around the muscles for isolation. The sclera was inspected and there was no evidence of thinning. The marking scleral depressor was then used to mark the retinal tear by indirect ophthalmoscopy. Cryotherapy was then applied around the retinal tear, which was located at the ten o'clock hour position and had an adjacent hole. There were…show more content… A 5-0 nylon suture was then placed in each of the 4 quadrants in a horizontal mattress fashion. The #450 band was placed beneath the rectus muscles and sutures and secured in the superonasal quadrant using a #72 sleeve. Buckle height was adjusted and two temporal sutures were tied. A cut down drain at the superior border of the medial rectus beneath the band using a #69 blade. A 30 gauge needle was advanced into the subretinal space and there was spontaneous aggressive fluid. There was only a small amount of fluid that did drain. The detachment was not very full of fluid and was relatively shallow. There was no evidence of any bleeding from the drainage site. The 2 nasal sutures were then tied and the buckle height again adjusted, and the retina was then inspected and the buckle height was excellent. There were still some fluid, supranasally, but less than previous, and the tear was supported by the buckle,
