D-ACE surgical sequence for selected bullous retinal detachments.

Abstract

SUMMARY Forty-five out of 50 selected retinal detachments were successfully reattached by the D-ACE surgical sequence, that is, initial drainage of subretinal fluid followed by air injection into the vitreous, transcleral cryopexy, and definitive scleral buckling. The D-ACE sequence is recommended for difficult bullous detachments as a simple, safe, and effective alternative to nondrainage techniques.

Does cryotherapy before drainage increase the risk of intraocular haemorrhage and affect outcome?. A prospective, randomised, controlled study using a needle drainage technique and sustained ocular compression

“…Gilbert and McLeod in their description of the DACE procedure state that one of the theoretical advantages of this sequence is that it could substantially reduce the risk of haemorrhage from the perforation site 13. However, no cases of cryotherapy before drainage were described in their study.…”

“…Many surgeons choose to drain just above or below the horizontal recti muscles in the watershed region of the vortex vein territories to reduce this risk of IOH 310 13 Other surgeons adopt a technique of transillumination to avoid puncturing choroidal vessels 15…”

“…Several authors have suggested a putative benefit of performing drainage before cryotherapy to avoid choroidal vasculature congestion and reduce the risk of IOH 910 12 13 However, the visualisation of retinal breaks using this sequence, particularly through a bubble, can be difficult. In addition, when injection is not required, the hypotony associated with drainage may conversely increase the risk of haemorrhage for subsequent cryotherapy.…”

Special Adjuncts to Treatment

“…13 The air injection is useful in three specific ways. When buoyancy was large, the bubble would take on the shape of the vitreous cavity and assume a flat bottom.…”

“…13 Aspiration of perfluorocarbon liquid (PFCL) from the anterior chamber at the slit lamp. A 27-gauge needle connected to a syringe with plunger removed, is inserted into the anterior chamber at near 6 o'clock position.…”