vitreous surgeryvitreous surgerydme.ap.nic.in/vitreous.pdf · “one may think that the vitreous is...
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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….”
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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
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l Pars plana Vitrectomy - Robert Machemer
l open sky vitrectomy- kasner
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HistoryHistory
l Robert Machemer & Colleagues
1971
VISC
l Peyman & Dodich
1971
vitreophage
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l Anesthesia General / Local
l Pre operation Instrument check
l Preparation of Patient
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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
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PeritomyPeritomy
l 360 limbal/Para limbal
l Limited
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Encircling Band Encircling Band
l Tagging of recti
l Band - anchor sutures/scleral tunnels
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Sclerotomies Sclerotomies
l 3 ports
l one port infusion cannula
l one port Active Instrument
l one for endo Illumination
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EndoilluminatorEndoilluminatorEndolaserEndolaser
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l Circumferential / Radial
lMVR Blade(20 G )
l 3.5mm Phakic
l 3mm Aphakia/Pseudophakia
l mattress/shoelace sutures
Sclerotomies Sclerotomies
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l Infusion cannula - 1st to go in last to come out
l ITQ
l always check the cannula
l 4mm/6mm tip
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Infusion Infusion cannulacannula
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To view RetinaTo view Retina
l Contact lenses
Machemer
Landers lenses
wide angle systems
l Non contact Viewing system
BIOM
EIBOS
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Machemer Machemer irrigating contact irrigating contact lenslens
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Landers lensesLanders lenses
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Basic VitrectomyBasic Vitrectomy
l Core Vitrectomy
l Routine Vitrectomy
l Base Excision
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Vitreous cutterVitreous cutter
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l Ant Vitrectomy
lMid & Post Vitreous - use of lens
l PVD induction
Flute/Soft
Vitrectomy Cutter
MVR
Visco dissection
Basic VitrectomyBasic Vitrectomy
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Plug forceps Plug forceps Flute needleFlute needle
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Membrane PeelingMembrane Peeling
l Segmentation
l Delamination
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SegmentationSegmentation
l Relieve traction when Broad attachment
l Atrophic Retina
l Vertical scissors
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DelaminationDelamination
l Point like attachment epicentres
l membrane removed in toto
l Curved scissors
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Membrane instrumentsMembrane instruments
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l Fluid gas exchange
l Air gas exchange
l Air silicone oil exchange
l LPFC Silicone oil exchange
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FGE tubingFGE tubing
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l Tightening of Band
l Sclerotomies closed 6 / 5 vicryl
l Antibiotic wash
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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
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ComplicationsComplications
l Lens touch
l Iatrogenic Retinal Breaks
l uncontrolled bleeding
l Retinal Incarceration
l Choroidal Bleeding
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Cryo Cryo probeprobe
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Endo Endo cauterycautery
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Fragmatome Fragmatome
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THANK YOUTHANK YOU
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