CASE OF THE MONTH

CASE #3

A 33-gauge infusion cannula was used to approach the CNV through an inferior retinotomy located just outside the inferotemporal arcade, approximately 2 disc diameters from the optic nerve. The CNV was freed from its underlying attachment to Bruch’s membrane. Next, balanced salt was carefully infused to reveal the exact location of retina-CNV adhesions. We used gentle blunt dissection with a subretinal pick to separate the CNV from its overlying attachment to the retina at the fovea and temporal to the optic nerve.

A second retinotomy was made just inside the superotemporal arcade to dissect an adhesion along the superior-nasal surface of the scar which could not be reached through the initial retinotomy. We used blunt dissection to lyse the adhesion between the scar and the retina, and the scar was completely freed from its overlying attachment to the retina without creating a retinal break. The Thomas forceps were introduced through the inferior retinotomy, and, with the intraocular pressure elevated, the CNV was grasped and gently pulled through the retinotomy, which enlarged to about 3/4 of a disc diameter with a slit-like configuration conforming to the nerve fiber layer. A significant portion of the CNV appeared to lie beneath the RPE.