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Gentle twisting motion during trocar insertion may reduce IOP elevation
The sutureless vitrectomy maneuver may avoid fluctuations in intraoperative IOP.
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 Pei-Chang Wu |
Adding a gentle twisting motion to trocar insertion for sutureless vitrectomy may significantly reduce IOP elevation, according to one researcher.
This simple technique for sutureless vitrectomy could potentially reduce intraoperative average IOP rise and IOP spike, as well as ocular deformity, according to Pei-Chang Wu, MD, PhD, and colleagues, who published a study on the technique in Retina.
“I noticed the scleral deformity was mild using the twisting maneuver in contrast to direct insertion. It suggested that the maneuver might reduce IOP elevation during trocar insertion,” Dr. Wu told Ocular Surgery News.
Dr. Wu and colleagues were motivated by the large number of patients with vascular compromise who cannot afford substantial IOP elevation.
“We often face vascular-compromised patients with diabetes, hypertension or advanced glaucoma. Keeping the IOP balanced is important to save the residual retinal and optic nerve function,” Dr. Wu said. “In addition, once the IOP surge induces intraocular fluid leakage from the corneal or scleral wound in the combined surgeries, the resulting hypotony might lead to severe complications, [such as] suprachoroidal hemorrhage.”
For the twisting technique, Dr. Wu uses a 25-gauge vitrectomy system from Alcon and slowly pushes forward the trocar cannula and trocar blade by rotating the shaft of the blade clockwise and then counterclockwise upon resistance. Insertion takes almost three times as long as direct insertion, resulting in a smaller, irregular wound, Dr. Wu said.
Dr. Wu recommended further studies to assess whether the irregular “zipped” incision might affect wound closure and whether the twisting maneuver could reduce the rate of postoperative hypotony.
As combined phacoemulsification and 25-gauge sutureless vitrectomy become increasingly routine, Dr. Wu and colleagues noted that trocar insertion should be conducted before phaco. Reduced globe resistance and instability of the cataract wound might make insertion more complex, they said, increasing the likelihood of acute IOP elevation and successive complications. If trocar insertion is performed after phaco, the gentle twisting technique may reduce these complications, though.
“Trocar insertion beforehand is still recommended in routine surgeries of combined phaco and pars plana vitrectomy,” Dr. Wu said. – by Michelle Pagnani
Reference:
- Wu PC, Tiong IS, Chuang YC, Kuo HK. Twisting maneuver for sutureless vitrectomy trocar insertion to reduce intraoperative intraocular pressure rise. Retina. 2011;31(5):887-892.
- Pei-Chang Wu, MD, PhD, can be reached at Department of Ophthalmology, Kaohsiung Chang Gung Memorial Hospital, 123 Dapi Road, Kaohsiung, 83301 Taiwan; 886-7-7317123, ext 2801; email: wpc@adm.cgmh.org.tw.
- Disclosure: Dr. Wu has no direct financial interest in the products discussed in this article, nor is he a paid consultant for any companies mentioned.
