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Surgeon shares pearls for vitrectomy in complicated cataract cases
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ROME — Anterior vitrectomy is an important skill for cataract surgeons, who might find it necessary to remove the vitreous from the anterior segment in complicated cataract cases.
In giving pearls about vitrectomy for the cataract surgeon at the annual joint meeting of Ocular Surgery News and the Italian Society of Ophthalmology, Keith Warren, MD, said that small-gauge surgery is advantageous for the anterior segment surgeon, although some potential drawbacks have to be considered.
"Small-gauge cutters have advantages, as they require a sutureless self-sealing incision, resulting in less morbidity and faster recovery. However, vitrectomy time is longer, and surgeons must develop skills to be able to use the flimsy instrumentation provided for this technique," he said.
Cutters can be used for various purposes in combined cataract-vitrectomy procedures, such as iridotomy, capsulotomy and cortical removal. However, the different tissues require variable cutter speeds, and current cutters perform poorly for nucleus removal, he said.
Recommended settings for small-gauge cutters are a vacuum of 300 mm Hg to 400 mm Hg and a cut rate of 900 to 1,200 cuts per minute, but these settings, which are the best for removing the vitreous, need adjustments for the cortex, iris and capsule.
Dr. Warren also noted the importance of visualization, which can be enhanced by triamcinolone or blood and recommended "not to cut what cannot be seen."