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How to do an anterior vitrectomy
MC04: Vitreoretinal update
Dr Somdutt Prasad
MS (Cal) FRCS (Edin) FRCOphth (Lond) FACS (USA)
Consultant Eye Surgeon & Retina Specialist
AMRI Hospitals & i4vision, Kolkata, India
sprasad@rcsed.ac.uk +91 9830507754
www.somduttprasad.com
No financial interest
Outline
• Bimanual Anterior Vitrectomy
• Dry Anterior Vitrectomy
• Pars plana anterior vitrectomy
• Optional manoeuvres
– Optic Capture
– PC tear → PCCC
• Finishing & Post Operative plan
When the PC tears...
• Stop US and aspiration
• Keep irrigation on (position 1)
• Avoid AC collapse
Bimanual Anterior Vitrectomy
• Most useful technique
• Separate irrigation and
aspiration/cutting
– Irrigation directed anteriorly
– Cutter clears presenting vitreous;
placed through PC tear pointed
posterior and vitreous
Machine Paratmeters
• Low bottle height
• High cut rate 1500-2000/min
• Aspiration 150-250 mmHG
• When dealing with lens matter clear
of vitreous drop cut rate to 300/min
Machine settings
• B&L Millenium / Stellaris
– Dual Linear
• Alcon / others
– Irr – Cut – Asp (for Vit)
– Irr – Asp – Cut (for lens matter)
Dry Anterior Vitrectomy
• Usually suitable if small amount of
vitreous presenting towards end of
procedure.
• High cut rate 500-750/min
• Refill with visco if AC shallows
Single pars plana port
Optic Capture
PC tear → PCCC
• Only in very select circumstances
– Small, central PC tear
• Do not compromise anterior capsule
whilst doing fancy manoeuvres with
PC !
Surgical technique
• Stay in control
• Avoid AC collapse
• Consider: PC tear → PCCC
• Deal with vitreous
– Triamcinolone
• IOL implant
– Sulcus – IOL power
– optic capture
– If PCCC achieved: in the bag
Surgical Technique
• Shut pupil
– Watch for peaks
– Reinstill triamcinolone
• Low threshold for wound suture
Post operative
• Treat IOP
– Avoid aqueous release
• Treat inflammation
– Kenalog granules may appear in AC:
pseudohypopyon
• Detailed fundus evaluation before
discharge
Excellent visual outcomes,
even with complication
occuring
sprasad@rcsed.ac.uk
Dr Somdutt Prasad
Thank You
www.somduttprasad.com

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How to do an anterior vitrectomy

  • 1. How to do an anterior vitrectomy MC04: Vitreoretinal update Dr Somdutt Prasad MS (Cal) FRCS (Edin) FRCOphth (Lond) FACS (USA) Consultant Eye Surgeon & Retina Specialist AMRI Hospitals & i4vision, Kolkata, India sprasad@rcsed.ac.uk +91 9830507754 www.somduttprasad.com
  • 3. Outline • Bimanual Anterior Vitrectomy • Dry Anterior Vitrectomy • Pars plana anterior vitrectomy • Optional manoeuvres – Optic Capture – PC tear → PCCC • Finishing & Post Operative plan
  • 4. When the PC tears... • Stop US and aspiration • Keep irrigation on (position 1) • Avoid AC collapse
  • 5.
  • 6. Bimanual Anterior Vitrectomy • Most useful technique • Separate irrigation and aspiration/cutting – Irrigation directed anteriorly – Cutter clears presenting vitreous; placed through PC tear pointed posterior and vitreous
  • 7. Machine Paratmeters • Low bottle height • High cut rate 1500-2000/min • Aspiration 150-250 mmHG • When dealing with lens matter clear of vitreous drop cut rate to 300/min
  • 8. Machine settings • B&L Millenium / Stellaris – Dual Linear • Alcon / others – Irr – Cut – Asp (for Vit) – Irr – Asp – Cut (for lens matter)
  • 9.
  • 10. Dry Anterior Vitrectomy • Usually suitable if small amount of vitreous presenting towards end of procedure. • High cut rate 500-750/min • Refill with visco if AC shallows
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  • 24. PC tear → PCCC • Only in very select circumstances – Small, central PC tear • Do not compromise anterior capsule whilst doing fancy manoeuvres with PC !
  • 25.
  • 26. Surgical technique • Stay in control • Avoid AC collapse • Consider: PC tear → PCCC • Deal with vitreous – Triamcinolone • IOL implant – Sulcus – IOL power – optic capture – If PCCC achieved: in the bag
  • 27. Surgical Technique • Shut pupil – Watch for peaks – Reinstill triamcinolone • Low threshold for wound suture
  • 28. Post operative • Treat IOP – Avoid aqueous release • Treat inflammation – Kenalog granules may appear in AC: pseudohypopyon • Detailed fundus evaluation before discharge
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  • 31. Excellent visual outcomes, even with complication occuring sprasad@rcsed.ac.uk
  • 32. Dr Somdutt Prasad Thank You www.somduttprasad.com