VITREOUS SURGERYVITREOUS SURGERYdme.ap.nic.in/vitreous.pdf · “One may think that the vitreous is merely a homogenous jelly without soul or feeling. However the moment one breaks

VITREOUS SURGERYVITREOUS SURGERY

DR.SATISH G AGRAHARAMDR.SATISH G AGRAHARAM

VITREO RETINAL INSTITUTE

HYDERABAD

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JOHNSON archives of JOHNSON archives of ophthalmology 1941ophthalmology 1941

“One may think that the vitreous is merely a homogenous jelly without soul or feeling. However the moment one breaks through the so called hyaloid membrane, whether with a knife or forceps, one disturbs a most intricate and complicated structure, consisting of a network of fine transparent fibres…. And lymph… spaces which are throbbing with life and through which stream of nourishment is continually flowing… The practical point is that one must never touch the vitreous if it can be avoided….”



Phases in Retinal SurgeryPhases in Retinal Surgery

l 1923 to 1970 Scleral Buckling

l 1970 to 1980 General Vitreous Surgery

l 1980 onwards advanced VR surgery with Vitreous Substitutes



l Pars plana Vitrectomy - Robert Machemer

l open sky vitrectomy- kasner



HistoryHistory

l Robert Machemer & Colleagues

1971

VISC

l Peyman & Dodich

1971

vitreophage



l Anesthesia General / Local

l Pre operation Instrument check

l Preparation of Patient



Basic Vitrectomy technique Basic Vitrectomy technique

l Peritomy

l Encircling Band

l Sclerotomies

l Contact lenses

l Vitrectomy

l Membrane Sx.

l Vitreous Substitutes

l Closure



PeritomyPeritomy

l 360 limbal/Para limbal

l Limited



Encircling Band Encircling Band

l Tagging of recti

l Band - anchor sutures/scleral tunnels



Sclerotomies Sclerotomies

l 3 ports

l one port infusion cannula

l one port Active Instrument

l one for endo Illumination



EndoilluminatorEndoilluminatorEndolaserEndolaser



l Circumferential / Radial

lMVR Blade(20 G )

l 3.5mm Phakic

l 3mm Aphakia/Pseudophakia

l mattress/shoelace sutures

Sclerotomies Sclerotomies



l Infusion cannula - 1st to go in last to come out

l ITQ

l always check the cannula

l 4mm/6mm tip



Infusion Infusion cannulacannula



To view RetinaTo view Retina

l Contact lenses

Machemer

Landers lenses

wide angle systems

l Non contact Viewing system

BIOM

EIBOS



Machemer Machemer irrigating contact irrigating contact lenslens



Landers lensesLanders lenses



Basic VitrectomyBasic Vitrectomy

l Core Vitrectomy

l Routine Vitrectomy

l Base Excision



Vitreous cutterVitreous cutter



l Ant Vitrectomy

lMid & Post Vitreous - use of lens

l PVD induction

Flute/Soft

Vitrectomy Cutter

MVR

Visco dissection

Basic VitrectomyBasic Vitrectomy



Plug forceps Plug forceps Flute needleFlute needle



Membrane PeelingMembrane Peeling

l Segmentation

l Delamination



SegmentationSegmentation

l Relieve traction when Broad attachment

l Atrophic Retina

l Vertical scissors



DelaminationDelamination

l Point like attachment epicentres

l membrane removed in toto

l Curved scissors



Membrane instrumentsMembrane instruments



l Fluid gas exchange

l Air gas exchange

l Air silicone oil exchange

l LPFC Silicone oil exchange



FGE tubingFGE tubing



l Tightening of Band

l Sclerotomies closed 6 / 5 vicryl

l Antibiotic wash



Indications for VitrectomyIndications for Vitrectomy

l Non absorbing Vitreous hemorrhage

l RD with PVR C2 & >

l TRD

l CRD

l Endophthalmitis

l Dropped Nucleus/IOL

l IOFB



ComplicationsComplications

l Lens touch

l Iatrogenic Retinal Breaks

l uncontrolled bleeding

l Retinal Incarceration

l Choroidal Bleeding



Cryo Cryo probeprobe



Endo Endo cauterycautery



Fragmatome Fragmatome



THANK YOUTHANK YOU



VITREOUS SURGERYVITREOUS SURGERYdme.ap.nic.in/vitreous.pdf · “One may think that the vitreous is merely a homogenous jelly without soul or feeling. However the moment one breaks

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