Chandelier-assisted bimanual technique for securing infusion in eyes with hazy media.

Purpose: Hazy media with resultant difficulties in visualisation hamper the surgical approach and outcomes in various vitreoretinal surgical scenarios, including eyes with keratoprosthesis in situ. We propose a novel chandelier-assisted bimanual infusion using a flute needle to overcome the inability to secure infusion safely in such eyes.

Methods: The surgical technique was performed with the assistance of chandelier illumination. The irrigation tubing from the vitrectomy machine was connected to a flute needle for infusion. A bimanual technique was utilized with the flute needle connected to infusion in one hand and the cutter in the other hand.

Results: A 34-year-old monocular male patient with a keratoprosthesis in his seeing eye developed late-onset endophthalmitis with retroprosthetic membranes. The visual acuity had dropped from 20/20 to hand motions. Our novel bimanual technique helped secure infusion safely for vitrectomy. The patient recovered well to a visual acuity of 20/60 with a good anatomical outcome.

Conclusion: Early vitrectomy may be essential for ensuring optimal outcomes in certain eyes with endophthalmitis. Surgical intervention in eyes with keratoprosthesis with secondary endophthalmitis is challenging due to difficulties in visualisation. This was overcome in our case with a novel bimanual chandelier-assisted technique for securing infusion.