Surgeon: Oblique incision in vitrectomy preferred

RIO GRANDE, Puerto Rico — Regardless of which vitrectomy system a retinal surgeon prefers, using an oblique incision instead of a straight incision will help the cannula stay in better, said Frank H.J. Koch, Prof. Dr. med. He presented his observations with the II 4000 high-resolution endoscope on the Alcon, Bausch & Lomb, DORC and Midlab vitrectomy systems.

“All systems have to be handled differently to have an optimized profit from each of them,“ he said here to attendees of the Masters of the American Society of Retina Specialists meeting.

Straight vitrectomy systems — such as the Alcon and Bausch & Lomb — should be inserted obliquely anyway, Dr. Koch said.

“Don’t forget to displace the conjunctiva,” he warned.

Once the incision is made, surgeons need to determine how much screwing of the port is necessary, he said. He recommends 20° to 25°.

“Using an oblique angle is easier,” he said. “But when does incarceration happen? How much do we need? How much can we tolerate?” Once a surgeon pulls back the trocar, in most cases, he said, vitreous will be incarcerated in the cannula.

“The size of the cannula is not important,” he said.

He urged surgeons to clean the ports at the beginning and end of the surgery.

“Use an oblique insertion, clean the entry port, keep pressure on the eye during explantation,” he said.

“In short, different mini-gauge approaches afford completely different strategies to perform a successful pars plana vitrectomy,” he said. Surgeons should consider using oblique insertion of ports rather than straight, cleaning ports and entry sites, and maintaining pressure during explantation to have a successful surgery.