Anterior Vitrectomy Process by Dr Somdutt Prasad at APACRS 2015
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Transcript of Anterior Vitrectomy Process by Dr Somdutt Prasad at APACRS 2015
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
[email protected] +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
Dr Somdutt Prasad [email protected]
Thank Youwww.somduttprasad.com