This 13 year old girl is a high myope but has no family history of retinal detachment. She presented with one week of very poor vision in the right eye. The video shows the repair of a 300 degree giant retinal tear retinal detachment. These detachments are MUCH different from the usual retinal detachment. The techinque shows a vitrectomy with perfluoron then laser. The laser does not hold right away and the perfluoron cannot be left in the eye, so silicone oil is infused at the end of the case. I use a direct perfluoron silicone oil exchange. This techinque prevents slippage of the anterior edge of the retina where the giant tear was. The reason it works better than going from perfluoron to air to silicone oil is that the interface tension between the air and perfluoron is much more than the interface tension between the silicone oil and perfluoron. That interface tension is what pushes the retina out of position (slippage). The patient is phakic. Some people remove the lens when repairing a giant retinal tear detachment. I did not do that. It was not necessary. In addition, I placed an encircling buckle around the eye at the beginning of the case. The buckle does nothing for the 300 degrees where the retina is torn. It does, however, support the 60 degrees of non-torn retina. The silicone oil will likely be left in this eye for years.

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