VITRECTOMY

Dr. Ankit PunjabiP.G. Ophth, Dept Of Ophthalmology

K.I.M.S., Hospital,Bangalore

Email: drankitalways@gmail.com

INTRODUCTION

• 2ND most common intraocular surgery• Until 1960’s : Don’t Violate Vitreous• 1971: Machemer – 1st planned vitrectomy• 1972: O’Malley & Heinz – 3-port vitrectomy• Recently : 23 and 25-gauge vitrectomy

APPLICATIONS

• Removal of vitreous opacity• Removal of IOFB / dislocated lens / IOL• Repair of RD or retinal Distortion• Control of NV of iris and retina

INDICATIONS

• RETINAL DETACHMENT• DIABETIC RETINOPATHY• TRAUMA• MACULAR SURGERY• PEDIATRIC RETINAL DISORDERS• TUMORS• COMPLICATED ANT SEGMENT SURGERY• UVEITIS

Retinal Detachment

• RD with Proliferative Vitreoretinopathy• Giant retinal tears• RD with posterior retinal breaks• Selected primary RD

Diabetic Retinopathy

• Non-clearing repeated VH• TRD• Combined RD• Progressive fibrovascular proliferation• Macular distortion by fibrovascular proliferation• Macular Edema from taut posterior hyaloid

Trauma

• Traumatic cataract / dislocated lens• Posterior penetration injuries with VH/RD• IOFB• Subretinal membranes / hemorrhage• Traumatic macular holes

Macular Surgery

• Macular pucker• Macular hole• CNV• Massive subretinal hemorrhage• VMT syndrome• Macular translocation• Transplantation of Photoreceptors or RPE

Pediatric Retinal Disorders

• ROP• PHPV• Familial exudative vitreoretinopathy• Giant retinal dialysis/ tears• Juvenile retinoschisis• Juvenile RA• RD secondary to choroidal coloboma• RD in “morning glory” syndrome / optic disc

coloboma

Tumors

• Choroidal melanoma• Complications of retinal angiomatosis• Combined hamartoma of retina & RPE• Intraocular lymphoma• Diagnostic vitrectomy

Complicated Ant Segment Surgery

• Dislocated lens fragments• Dislocated IOL• Aphakic / pseudophakic CME• Endophthlamitis• Choroidal hemorrhage• Anesthetic needle perforation

Uveitis

• Viral retinitis• Intraocular infections• Ophthalmomyosis• Inflammatory:– Bechet’s Disease, sarcoidosis, uveal effusion syndrome

• Pars planitis• Whipple’s disease• Hypotony

INSTRUMENTATION

• VITRECTOMY SYSTEMS– 3-port systems– Combined-function instruments

• VISUALIZATION– Hand-held irrigating contact lens– Floating of sutured contact lens– Wide-angle lens– Keratoprosthesis– Operating microscope– Intraocular endoscope

• ILLUMINATION– Fibreoptic light pipe– Fibreoptic light sleeve– Fibreoptic light canula– Illumination collars– From microscope

• INFUSION– Infusion canula– Infusion sleeves– Air pump-silicone oil pump

• INSTRUMENTS– Scissors– Forceps– Picks– Ultrasound needles for lens removal– Aspiration catheters– magnets

• ANCILLARY INTRAVITRIAL DRUGS & AGENTS– Epinephrine, antibiotics, antiinflammatory,

antiproliferative, tPA, hyaluronic acid, thrombin

• PHOTOCOAGULATION– Endophotocoagulation : endolaser / endoxenon– IO photocoagulation– Transscleral laser

• CRYOTHERAPY– Transscleral / transvitreal

• DIATHERMY– Transvitreal

• Bipolar unimanual / bimanual

– Transscleral

• SCLERAL BUCKLING ELEMENTS– Silicone sponges– Solid silicone plates– Silicone bands

• TAMPONADES– Air– Long-acting gases– Silicone oil– Liquid perflourochemicals

• CYANOACRYLATE GLUE• TACKS ( retina and iris)• SUTURES (retina and iris)• GIANT TEAR TABLE (used in historical era)

DORC Harmony TTC

• Dual Fiber Optic Illumination

• High Frequency Diathermy

• Air-Fluid Exchange

• Viscous Fluid Injection

• Vitrectomy, high speed, dual linear control

• Phaco Emulsificalion & Fragmentation, dual linear control

• Irrigation / Aspiration & Viscous Fluid Extraction

• DORC Dual Linear Venturi

Surgical Anatomy

»Video

BASIC TECHNIQUE

»Video

25-GAUGE VITRECTOMY SYSTEM

25-gauge system Trocars

25-gauge system vitreous cutters

Xenon light source.

The forceps, the vertical scissors,and the curved scissors

20-gauge 23-gauge 25-gauge Forceps

Pressure Plate

Forceps with scale marks

25-gauge chandelier illumination

20-gauge and 25-gauge illuminated infusion cannula. Diameter is 500 & 380 um respectively

Optical fiber-free intravitreal surgery system (OFFISS)

Associate 2500

Advanced Dual System, Phaco and VitrectomyTwin Pump System, Peristaltic and Venturi

Bimanual Cool Phaco / M.I.C.S.High Speed Vitrectomy, 20, 23 and 25 gauge compatible

Complication of Vitrectomy

• Retinal breaks• Retinal detachment• Choroidal hemorrhage• Vitreous hemorrhage• Subretinal hemorrhage• Choroidal detachment• Cataract• Dislocation of existing intraocular lens• Corneal decompensation• Hypotomy• Fibrovascular growth in sclerotomy

• Endophthalmitis• Lid abnormalities• Neovasculariion of iris• Glaucoma• Anterior hyaloid fibrovascular priliferation• Scleral buckle infection/extrusion• Anterior segment necrosis• Retinal vascular occlusion• Optic atrophy

Thank You