A 3-month-old child who was born at full term with a history of thrombocytopenia and NICU entry was referred to the Bascom Palmer Eye Institute in Miami following observation of abnormal red reflex. I observed a dense vitreous hemorrhage (Figure 1) and brought the patient to the OR. It should be noted that genetic profiling suggested that the patient’s condition was unrelated to genotype.
Figure 1. Dense vitreous hemorrhage was observed in a 3-month-old patient. Use of the heads-up NGENUITY 3D Visualization System platform assisted in identifying various planes during surgery.
Finding surgical planes is a difficult task, particularly in a case such as this that involves a small eye with dense vitreous hemorrhage. Because I used the heads-up NGENUITY 3D Visualization System (Alcon) for this surgery, I was able to more easily ascertain the distinctions between surgical planes by toggling between various color filters. I also relied on intraoperative OCT imaging to help me identify tissue layers during membrane dissection and peeling (Figure 2).
Figure 2. Use of intraoperative OCT during membrane dissection and peeling helped distinguish retinal tissue from membrane tissue.
Surgery in a small eye with complex anatomy can be difficult, and I advise placing patients under oil in such cases (as I did here). Removal of oil may be possible at a later date.
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