Tadayuki Nishide*, Ikuko Kimura, Natsuki Hayakawa, Yoko Yagi, Etsuko Shibuya, Reiko Yasumura and Nobuhisa Mizuki
Department of Ophthalmology and Visual Science, Yokohama City University Graduate School of Medicine
Received: 28 February, 2014; Accepted: 09 May, 2014; Published: 11 May, 2014
Tadayuki Nishide, Department of Ophthalmology and Visual Science, Yokohama City University Graduate School of Medicine, 3-9, Fukuura, Kanazawa-ku, Yokohama-city, Kanagawa, post code: 236-0004, Japan, Tel: +81-45-787-2683; Fax: +81-45-781-9755; Email: email@example.com
Nishide T, Kimura I, Hayakawa N, Yagi Y, Shibuya E, et al. (2014) The "Crocodile Technique": A New Ophthalmic Surgical Technique to Remove Subretinal Proliferative Tissue Associated with Retinal Detachment. J Clin Res Ophthalmol 1(1): 001-005. DOI: 10.17352/2455-1414.000001
© 2014 Nishide T, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Crocodile technique; Subretinal proliferative tissue; Retinal detachment; A new surgical technique; Vitreous forceps
SPT: Subretinal Proliferative Tissue; RPE: Retinal Pigment Epithelium
Purpose: To describe the "crocodile technique", a new ophthalmic surgery technique for removing subretinal proliferative tissue (SPT) associated with retinal detachment.
Materials and Methods: Subjects were 21 patients who had retinal detachment with SPT. Their follow-up terms were all greater than 3 months. We undertook the crocodile technique during their subretinal surgery. The crocodile technique is a new ophthalmic technique for removing SPT using vitreous forceps, without using subretinal forceps, in small-gauge vitrectomy. After performing sufficient peripheral vitrectomy, a small intentional retinal tear was created above the SPT. The SPT was then stabilized while grasped by vitreous forceps in the subretinal space. The vitreous forceps were then rotated on their long axis, such that the SPT was rolled around the vitreous forceps in the subretinal space.
Results: The crocodile technique was successfully performed without enlarging the intentional retinal tear or creating new retinal tears, in all subjects. The retina was successfully reattached in all subjects, postoperative average visual acuity was improved after surgery, and postoperative re-detachment did not occur in any patients.
Conclusions: The crocodile technique can be performed without subretinal forceps. Using the technique, retinal detachment with SPT can be treated using vitreous forceps in small-gaugevitrectomy.
Proliferative changes are observed in approximately 20% of retinal detachment cases for which surgery is deemed necessary . In retinal detachments accompanied by proliferative changes, re-detachment following surgical repair often occurs because the subretinal proliferative tissue (SPT) creates a barrier between the retina and the retinal pigment epithelium (RPE), compromising retinal reattachment. Visual recovery in these cases is poorer than in cases with no proliferative changes [1,2]. Therefore, in cases of severe retinal detachment with SPT, SPT removal is necessary before retinopexy is performed. However, small-gauge subretinal forceps (23-gauge, 25-gauge, and 27-gauge) do not exist. If subretinal forceps are needed in small-gauge vitrectomy, it must be enlarged to a 20-gauge vitrectomy to accommodate them. Additionally, subretinal forceps have a curved tip and cannot be inserted from the small-gauge trocar.
In conventional SPT removal vitrectomy, an intentional retinal tear is created and the SPT is grasped below the retina using vitreous forceps. In order to remove the SPT, it is lifted up, often enlarging the intentional retinal tear and the retinal detachment (Figure 1A, B). Herein, we present a new ophthalmic surgical technique that was used to remove SPT associated with retinal detachment, using small-gauge vitreous forceps. Using our new ophthalmic surgical technique, we can operate on the SPT in a small working space. Furthermore, we can substantially reduce the size of the SPT via a rolling action. Because the new ophthalmic surgery technique resembles the rotating behaviour that a crocodile exhibits while gripping a prey animal, we called it the crocodile technique.