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New vitrectomy instruments aid surgery in diabetic eyes
 Borja Corcóstegui |
VIENNA, Austria — Newly developed vitrectomy instruments facilitate both single-handed and bimanual dissection of fibrovascular tissue during vitrectomy for proliferative diabetic retinopathy, according to a specialist here.
"Considering that a sutureless procedure is not the principal aim of this surgery, any cutter size can be used for the removal of proliferative membranes. However, 23-gauge or 25-gauge with variable duty cycle and port close to the tip of the cutter are nowadays the most widely accepted choice," Borja Corcóstegui, MD, said at the Advanced Retinal Therapy meeting.
Three sclerotomies, if placed correctly, are usually sufficient to extract all proliferations, Dr. Corcóstegui said.
The amount and extension of vitreoretinal adhesions can be evaluated by fundoscopy or B-mode ultrasound scan.
"We need to differentiate between proliferative tissue with a relative extension and tissue with complete extension and attached posterior hyaloid. The cases with less adhesions have usually a better prognosis," Dr. Corcóstegui said.
The goal of fibrovascular tissue dissection is to remove as much proliferative tissue as possible, avoiding damage to the healthy retina and retinal vessels.
"Fibrovascular adhesions located in the retinal mid-periphery can be left unpeeled in many occasions if there is a risk of tearing the retina of major vessels," Dr. Corcóstegui said.
Scleral buckling can be used in severe cases.
Good team organization, working quickly at a high IOP, avoiding bleeding and minimizing diathermy use are also important, Dr. Corcóstegui said.
- Disclosure: Dr. Corcóstegui is a consultant for Alcon Laboratories.