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Keep vitreous traction to an absolute minimum in anterior vitrectomy
WAIKOLOA, Hawaii — The primary goal of an anterior vitrectomy is to remove vitreous gel, but there are various essential secondary goals, according to a speaker here at Hawaiian Eye 2019.
Kevin M. Miller, MD, said, in his 30,000 foot-view of anterior vitrectomy, that the most important thing to keep in mind is keeping vitreous traction to an absolute minimum.
A peaked pupil, a decentered lens and a wound leak can all result from a poorly performed vitrectomy, Miller added.
He said both anterior or pars plana approaches work well.
He recommends using trocars “if you will be in and out of the eye several times.”
Place the cut/aspiration post in the vitreous cavity, which can be done using a limbal approach, he said.
“Keep in mind not to pull the vitreous into the anterior chamber, which will enlarge posterior capsule tears and places greater traction on the vitreous,” Miller said.
The irrigation/pressurization line can be placed in the anterior chamber or in the vitreous cavity, he said.
When encountering trouble visualizing the vitreous, use triamcinolone to stain, he added.
He also recommends understanding the difference between the vitrectomy modes on the cataract machine. – by Abigail Sutton
Reference: Miller KM. Anterior vitrectomy for cataract surgeons: Fundamentals. Presented at: Hawaiian Eye; Jan. 19-25, 2019; Waikoloa, Hawaii.
Disclosures: Miller reports financial interests with Alcon, Johnson & Johnson Vision and Zeiss.