title: Trans-scleral dye injection during vitreous surgery to identify clinically undetectable retinal breaks causing retinal detachment.
abstract: OBJECTIVE
  Finding all retinal breaks is a critical step in rhegmatogenous retinal detachment (RRD) surgery in order to prevent persistent/recurrent retinal detachment (RD). We describe a technique of trans-scleral dye injection into the subretinal fluid under the detached retina in the context of recurrent/persistent RD in vitrectomized eyes, in order to determine the location of clinically unidentified (occult) retinal breaks causing RD.
  
  
  METHODS
  Retrospective consecutive single-surgeon case-series analysis of patients presenting with a repeat RRD after having been treated with pars plana vitrectomy (PPV) as the method of primary RRD repair. Trans-scleral injection of subretinal vision blue (TSVB) was used to help identify retinal breaks during repeat vitrectomy.
  
  
  METHODS
  successful detection of a break; location of breaks; persistent retinal attachment; final visual acuity (VA); complications.
  
  
  RESULTS
  There were 395 cases of RRD during the 3-year period reviewed. TSVB was used for eight instances in seven eyes. All eight instances were repeat RRD. TSVB facilitated occult break detection in 7/8 instances of use. Breaks were at or adjacent to the previous cryo site in three instances. Persistent retinal attachment was achieved in 5/7 cases. Final VA increased in 5/7 cases. There was no evidence of complications as a result of TSVB injection.
  
  
  CONCLUSIONS
  TSVB coupled with indentation to vent a plume of dye through an occult break during vitreous surgery is a relatively simple technique that may facilitate the identification of occult retinal breaks and help achieve anatomical success and functional success.
authors.affiliation: Department of Ophthalmology, Norfolk and Norwich University Hospital, Colney Lane, Norwich, UK. dgupta_01@yahoo.com
authors.forename: D
authors.initials: D
authors.lastname: Gupta
authors.forename: J
authors.initials: J
authors.lastname: Ong
authors.forename: R L
authors.initials: RL
authors.lastname: Burton
mesh_terms: D000368:Aged; D004396:Coloring Agents / Q000008:administration & dosage; D042241:Early Diagnosis; D006801:Humans; D056965:Injections, Intraocular; D007430:Intraoperative Care / Q000379:methods; D008297:Male; D008875:Middle Aged; D012163:Retinal Detachment / Q000209:etiology* / Q000503:physiopathology / Q000517:prevention & control; D012167:Retinal Perforations / Q000175:diagnosis* / Q000503:physiopathology; D012189:Retrospective Studies; D012590:Sclera; D055502:Secondary Prevention; D014343:Trypan Blue / Q000008:administration & dosage; D014792:Visual Acuity; D014821:Vitrectomy / Q000379:methods*
chemical_list: D004396:Coloring Agents; D014343:Trypan Blue