Purpose This study aims to describe chandelier assisted scleral buckle (CSB) using 3D visualizing system in phakic uncomplicated Rhegmatogenous Retinal Detachment (RRD). Methods This technique was performed in 6 eyes of 6 patients with primary rhegmatogenous RD who underwent encircling circumferential scleral buckling with scleral tunnels. Heads up display 3D system was used for visualization and localization of the breaks, and Chandelier Endoillumination was used as a light source was inserted through a 27 G needle sclerotomy 3.5mm from the limbus. A partial-thickness scleral “belt-loop” tunnels in the four quadrants were created using crescent knife angle beveled (2.3 mm in width) to facilitate the smooth passage of the band a 240-silicone band as encircling circumferential buckle. Cryopexy was performed and the incision was closed with cautery or absorbable sutures. Results Primary attachment success of 5 out of 6 and overall success was 100%. No intraoperative or postoperative complications observed although fellows in training performed half the procedures. Conclusions Heads up Sutureless Chandelier assisted Scleral Buckle can achieve excellent anatomical success while improving ergonomics and training. Furthermore, it is a safe procedure with less risk of complications and retinal phototoxicity.
Cytomegalovirus (CMV) infection is a common viral infection in non-HIV immunocompromised posttransplant patients, which causes significant morbidity and mortality. We present a rare case of Isolated CMV retinitis in a non-HIV immunocompromised patient 7 years after a liver transplant. The 58-year-old patient was on Cell cept (mycophenolate mofetil), Tacrolimus, and Entecavir, and presented with decreased vision and floaters in the right eye. Vision in the right eye was 20/40, while examination revealed mild uveitis, retinitis, and a foveal-sparing subretinal detachment. The patient underwent a pars plana vitrectomy (PPV) with silicone oil, endolaser, and intravitreal Ganciclovir, with the silicone oil removed 10 months later. The patient's best corrected visual acuity (VA) was 20/60 in the affected eye 12 months after surgery. We speculate that his use of prophylactic Entecavir may have played a role in this unique clinical picture. We assume that the positive visual outcome was due to good VA at presentation, secondary to fovealsparing retinal detachment (RD); this entailed the use of intravitreal ganciclovir injection after surgery with systemic Ganciclovir, close follow-up, and planning surgical steps prior to the intervention. Conclusion: Careful surgical planning with the use of intravitreal ganciclovir injection after surgery and systemic Ganciclovir may improve the visual outcome in such presentation. Abbreviation Cytomegalovirus (CMV) infection is a common viral infection that lead to significant morbidity and mortality in non-HIV immunocompromised posttransplant patients [1]. Non-HIV related CMV retinitis has been reported in cases exposed to intensive immunosuppressive therapy for organ transplant [2]. Intraocular inflammation is more common in CMV retinitis, as seen in non-HIV immunocompromised patients than in patients with HIV infection [3,4]. Variable presentation of CMV retinitis in non-HIV immunocompromised patients has also been reported, with zone 1 involvement occurring in 55% of them at presentation [5]. Retinal involvement in CMV infection typically occurs later, in comparison to other organs. A number of different mechanisms play a role in this phenomenon. First, an earlier onset with considerable damage of the retina suggests a strong virus-mediated cytopathic component, which seems to respond better to intravenous Ganciclovir. The second pattern was observed at a later point, when maintenance immunosuppression is typically lower, such that the response to intravenous Ganciclovir was less successful [6]. The low incidence of ocular CMV involvement has been linked to the prophylactic use of antiviral agents in transplants patients [5]. Nevertheless, multiple risk factors in these patients have been found to increase the risk of CMV infection. These include: CMV seropositivity before transplantation, development of CMV reactivation in the first 100 days after transplantation, presence of chronic graft-versus-host disease (GVHD), and delayed engraftment of lymphocytes [5]. Certain immunosuppre...
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