I was wondering if anyone knows if it's possible to laser retinopexy a peripheral hole or tear at the slit lamp while holding up a 78D or a 90D lens. There are many times that I have a more clear and magnified view of the hole using the 78D at the slit lamp and having the patient look in the direction of the lesion than I do after I've switched to the indirect headset to laser it. It seems like it would be so much easier to simply retinopexy it at the slit lamp through the 78D -- except that I've never heard of anyone doing a laser at the slit lamp without using a contact lens.
laser retinopexy at the slit lamp
- Thread starter Dusn
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Theoretically it should be possible and no more risk than using an indirect laser hand lens. As with any indirect non-contact lens, you have the reversal and inversion of the image to contend with which is not the case with contact laser lenses. You still need one hand for the lens (although they have those holders that bolt to the headrest frame) and the other hand for the aiming joystick and the foot pedal. Just be sure your lens has no filters that would interfere with either your aiming beam or treatment wavelength.
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Also, you have the patient's blink and eye movement to contend with. That's easier to control while using a BIO than with a SL, because you have a free hand.
I'd recommend trying a 2.2 Panretinal lens for the BIO. I've yet to have a peripheral break I can't visualize well with it. Great field of view. Alternatively, use a 3-mirror contact lens. I think both would be safer than a 78D (or other) non-contact lens.
I'd recommend trying a 2.2 Panretinal lens for the BIO. I've yet to have a peripheral break I can't visualize well with it. Great field of view. Alternatively, use a 3-mirror contact lens. I think both would be safer than a 78D (or other) non-contact lens.
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Volk makes an attachable eyelid lift accessory for its 78D lens, a cone-shaped aluminum ring that attaches inside the lens ring flange by interference fit. It allows you to hold the lid open.
If it were me, I would go with a mirror contact lens, just my level of comfort there.
If it were me, I would go with a mirror contact lens, just my level of comfort there.
Thanks for the advice. I often use my ring finger to prop open the eyelid, while I'm holding the lens with my index and thumb, so that shouldn't be a problem. I think seeing small unpigmented holes is harder to do with the BIO but considering that most people find using the BIO easier, it may be that I'm just not practicing it enough. I'll try the 2.2.
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I've used a 78 to finish lasering a hole before-- I normally use a 3 mirror contact lens but one pt was having a difficult time and kept blinking forcefully and it kept coming off/getting bubbles etc. Finally I used my 78 for the last portion and just held the lids. I also like my view better with the 78 and the pt looking in the correct direction, compared to the indirect. Using it for the laser was a little nerve wracking though, since I had no control over the pt's eye. I was worried he'd look a different direction right as I lasered. It went fine but I won't do it routinely.
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Would recommend a contact lens, some give great peripheral views, don't necessarily need a 3 mirror. BIO is easier and faster in my hands but both work well. Keep in mind that oftentimes it is important to laser out to the ora, in which case, you really need to scleral depress and use BIO.
