OSLI Retina

October 2018

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October 2018 · Vol. 49, No. 10 799 ■ T E C H N I Q U E ■ A Novel Approach to In-Office Air-Fluid Exchange Utilizing a 27-Gauge Valved Trocar Cannula Sofia Prenner; Howard F. Fine, MD, MHSc BACKGROUND AND OBJECTIVE: To describe a new approach for in-office air-fluid exchange. PATIENTS AND METHODS: This manuscript describes a procedural technique. A retrospective chart re- view of three patients on whom the procedure was performed is presented. RESULTS: The authors have performed this novel procedure on three eyes of three patients. All pa- tients were followed for at least 3 months after the procedure. No short-term complications occurred, and no secondary procedures were required to achieve a near-complete air-fluid exchange. CONCLUSION: This novel technique is a reliable and reproducible procedure that allows for in-office air- fluid exchange with good results in this small co- hort of patients. [Ophthalmic Surg Lasers Imaging Retina. 2018;49:799-801.] INTRODUCTION In-office air-fluid exchanges have become less attractive given the cumbersome nature of standard techniques, availability of anti-vascular endotheli- al growth factor agents, and a reduced threshold for returning to the operating room when using local anesthesia and small gauge instrumentation. 12345 Liabilities with current techniques include pain with re-entry into the eye, difficulties maintaining a normotensive state and inability to actively eval- uate the completeness of the exchange. We present an approach (Supplementary Video available at www.healio.com/OSLIRetina) allowing for a simplified, well-tolerated, and effective means of performing in-office air-fluid exchange. We em- ploy a 27-gauge valved trocar cannula to allow for controlled exchange with excellent initial results. TECHNIQUE Topical gel-based or subconjunctival anesthesia is placed inferotemporally. The eye is prepped in the usual sterile fashion for in-office based intravit- real injection procedures. The patient is positioned on their ipsilateral shoulder so that the eye of con- cern is in the dependent position. A lid speculum is placed, and a 27-gauge valved trocar cannula (Al- con, Fort Worth, TX) is placed into the vitreous cav- From the Department of Ophthalmology, Rutgers — Robert Wood Johnson Medical School, New Brunswick, NJ. Originally submitted May 1, 2018. Revision received August 1, 2018. Accepted for publication September 9, 2018. The authors report no relevant financial disclosures. Address correspondence to Howard F. Fine, MD, MHSc, Department of Ophthalmology, Rutgers — Robert Wood Johnson Medical School, 10 Plum Street, Suite 600, New Brunswick, NJ 08901; email: hfine@njretina.com. doi: 10.3928/23258160-20181002-08

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