How to do an anterior vitrectomy

MC04: Vitreoretinal update

Dr Somdutt PrasadMS (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 sprasad@rcsed.ac.uk

Thank Youwww.somduttprasad.com