ASRS 2023: 'MacGyver-Inspired' endolaser option for chandelier-assisted scleral buckles

Richard B. Rosen, MD, shared insights from his presentation from ASRS 2023 on "New 'MacGyver-inspired' endolaser option for chandelier-assisted scleral buckles" with Sheryl stevenson, our Group Editorial Director.

Video Transcript

Editor's note - This transcript has been edited for clarity.

Sheryl Stevenson:

We're joined today by Dr Richard Rosen, who will be giving a presentation at this year's ASRS, regarding a new MacGyver-inspired endolaser option for chandelier-assisted scleral buckles. Now, that sounds really intriguing, playing off of the MacGyver-inspired option. So, tell us more about your talk.

Richard B. Rosen, MD:

Over the last few years, chandelier-assisted scleral buckling has become a favorite of ours. Basically, it gives us the visualisation that people really enjoy when they're doing vitrectomy surgery and the precision, so we can actually see where the retinal pathology is at very high magnification. The issue has always been: How do you treat the areas of retinal breaks that you want to treat. The standard ways have been either cryo, which has potential problems in terms of proliferative vitreoretinopathy, or using an indirect laser, which basically takes you back to the low magnification and makes it difficult, often, when you're working in the operating room.

I was trying to think of a way to utilise a standard endolaser or create something similar to a chandelier. So, I worked on the mathematics and tried to figure out how I could design something like this and sort of hit a wall. I was doing a case with one of my fellows, and I said, let's see if we just shorten the endoprobe, and make it the same length as a chandelier, and see if we can get a good uptake.

So, what I did was I took an 18-gauge angiocath and made a sleeve so that the tip of the laser is the same length as a standard chandelier, which we know is safe to put in the eye without causing any difficulties, and realized I only needed to increase the power about twice what we were normally used to using, which is not particularly high. We got a very nice uptake, and everything is completed under the microscope, and very neatly. So, we did a series of these just to see if it would work and some of my colleagues — I have a number of other colleagues in my service — they tried it out, and they all agreed that this seemed like a very simple way to go. So, that's what I'm presenting.

Sheryl Stevenson:

Well, that's certainly very innovative and a really great idea. Is there anything else that you'd like to add that we haven't touched upon?

Richard B. Rosen, MD:

You know, what's nice about it is that you can use it from the tools that are available in the operating room. We use the lighted laser probe, but you can use a standard laser probe and use it in in conjunction with a chandelier. So, there's different variations on the idea, and it's something that's affordable and accessible for anybody to use.