DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS: Macular hole, right eye.
POSTOPERATIVE DIAGNOSIS: Macular hole, right eye.
OPERATION PERFORMED: Pars plana vitrectomy with membrane peeling and gas fluid exchange, right eye.
SURGEON: John Doe, MD
ANESTHESIA: MAC.
COMPLICATIONS: None.
DESCRIPTION OF OPERATION: After informed consent was obtained, the patient was brought to the operating room and placed under brief anesthesia with propofol. Ten mL of 50/50 mixture of 0.75% Marcaine and 2% lidocaine was placed in a modified Van Lint lid block as well as a retrobulbar injection. The patient was then prepared and draped in the usual sterile fashion. A wire lid speculum was placed in the patient’s right eye.
A 270 degree conjunctival peritomy was then performed using 0.12 forceps and Westcott scissors. Excellent hemostasis was obtained with bipolar cautery. Scleral marks were then made 3 mm posterior to the corneoscleral limbus, in the lower temporal, supratemporal, and supranasal quadrants. The 6-0 Vicryl mattress suture was placed around the lower temporal mark. A 20 gauge MVR blade was then used to penetrate the vitreous cavity through this site. A 4 mm infusion cannula was then temporarily set in place. It was well visualized to be in the vitreous cavity through the pupil. Two superior sclerotomy sites were then each made with a 20 gauge MVR blade. Core vitrectomy was then performed. There was no posterior vitreous detachment. One was created using high suction vitreous cutter over the disk. Vitrectomy was then carried out as far as possible to the vitreous base.
Attention was then turned to the posterior pole where a rent was created in the internal limiting membrane, and it was grasped with intraocular forceps and carefully peeled off the surface of the macula. Careful indirect ophthalmoscopy scleral depression was then performed, and no peripheral retinal breaks were noted. The two superior sclerotomy sites were then each closed with interrupted 6-0 Vicryl suture in X fashion. The infusion cannula was removed and the mattress sutures tied up permanently. Conjunctiva was reapposed using two interrupted 7-0 Vicryl sutures. Subconjunctival injections of dexamethasone and Ancef were placed. An Atropine drop, Maxitrol ointment, and a patch and shield were then applied. The patient tolerated the procedure well. There were no complications.
