Bascom
Palmer
EYE INSTITUTE University of Miarffi School of Medicine
Anne Bates Leach Eye Hospital
900 N.W. 17th Strect o P.O. Box 016880 o Mian-ú, Florida 33101 (305)326-6000 Toll Free (800) 329-7000

                                                      OPERATIVE REPORT 

DATE OF SURGERY:	02/08/2000
PREOPERATIVE DIAGNOSIS:	Severe proliferative diabetic retinopathy, both eyes; neovascular glaucoma, right eye (the patient is now functionally monocular); status post multiple pan retinal photocoaquiation treatments, left eye.
POSTOPERATIVE DIAGNOSIS:	Severe proliferative diabetic retinopathy, both eyes; neovascular glaucoma, right eye (the patient is now functionally monocular); status post multiple pan retinal photocoaquiation treatments, left eye
SURGEON:
ASSISTANT:
OPERATION PERFORMED:	(All in the left eye) Pars plana vitrectomy, membrane peeling, endolaser, air-fluid exchange, silicone oll instillation.
ANESTHESIA:	Monitored anesthesia care.
COMPLICATIONS:	None
PROCEDURE:	After informed consent was obtained, the patient was brought to the preoperative waiting area, where he was met by the atterding surgeon, who administered a retrobulbar block to the patient's left eye without complication (with intravenous sedation). The patient then proceeded to the operating room, where he was prepped and draped in the usual sterile fashion for ophthalmic surgery.

A lid speculum was placed before his left eye and the ceiling mounted Zeiss operating microscope was positioned in front of his left eye. A superonasal peritomy, as weil as a temporal peritomy, was made, using Westcott scissors. Wet field cautery was used to control any bleeding on the scleral bed. Calipers set at four millimeters were used to mark the sciera inferotemporally, superotemporally, and superonasally. Around the inferotemporal mark, a 4-0 nylon suture was placed in a horizontal mattress suture type fashion, with partial- thickness scleral bites. An MVR biade was then passed through this mark, effectively makinga sclerotomy, and an infusion cannula was sutured into place, once it was confirmed via transcorneal endoillumination that the tip was free of retina or other tissue. Two superior scierotomies were made in a similar fashion, again with an MVR biade and again at the marks four millimeters posterior to the limbus. The eye was entered, being careful to avoid the lens, and a core vitrectomy was carried posterioriy and peripherally. Of note, the patient's retina was quite ischemic, with a large preretinal 1 posterior hyaloid membrane adherent through the macula, as weil as up to the equator, and even more peripheral. There was preretinal, as weil as intraretinal and subretinal bleeding. Likewise, there was a traction retinal detachment. We gradually tried to dissect some of these membranas. At one point, the attending physician aspirated an edge of a membrane, once it had been delaminated from the underiying retina, and a large sheet, inciuding the posterior hyaloid and preretinal fibrosis, was pulled up and through the macula. Fortunately, this was done without making any retinal breaks. This membrane went weil beyond the arcades and in fact into the periphery. The vitrectomy handpiece was used to vitrectomize this membrane. At this point, a more aggressive peripheral vitreous dissection was carried out, again being carefui to avold hitting the lens. An air-fluid exchange was then per-formed, using a Fiynn cannula. With the help of a Landers contact lens, 360,1 of heavy pan retinal photocoagulation were placed through the retina again (this had been done several times previousiy in the clinic, with a presumptive good laser take; however, intraoperatively for some reason we only saw laser uptake at the extreme periphery anteriorly. This is odd, as the patient has had multiple treatments from multiple doctors, with a very dense pan retinal photocoagulation in the clinic). Then, the laser was used to place this laser and we carne all of the way posterioriy to the arcades. Silicone oil was then instilled via the superotemporal sclerotomy up to the superonasal sclerotomy, having closed using 7-0 Vicryl suture. The superonasal sclerotomy was closed, using 7-0 Vicryl suture. The inferotemporal sclerotomy was opened by removing the infusion cannula, and Vicryl was placed through this sclerotomy (two throws). Enough oil was expressed to leave the eye at a pressure of about 10 mm Hg. At this point, this sclerotomy was closed and tied in place with a preplaced suture. The conjunctiva was then reapproximated and closed, using 6-0 plain suture. The patient tolerated all of the above procedures well. There were no complications. He proceeded to -llhe Recovery Room 'in good cond'ition. Dr. TM was present for the entire procedure.
Surgeon select appropriate statement and sign:

1 was present for the entire procedure? Y/ N (Please underline)
 

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