Retina expert shares vitrectomy pearls for cataract surgeons
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KIAWAH ISLAND, S.C. — Not chasing lens material in the vitreous with a phaco probe, not attempting to use irrigation and not using a lens loop when dealing with a capsule rupture were some of the pearls shared in a presentation here.
Steve Charles, MD, offered these and other lessons on what to do and what not to do when performing vitrectomy for capsular rupture during cataract surgery in a presentation at Kiawah Eye.
“Lens material has never damaged a retina — surgeons damage retinas,” he said. He advised against chasing after nuclear material in the vitreous.
“Forget about the idea that lens material is going to damage the retina,” he said.
Instead, Charles advocated for using viscoelastic to create a barrier between the capsular defect and the vitreous body.
For lens material dropped into the vitreous, the first actions should be to pause, relax and plan the approach.
“Not all dislocated lens material needs surgery. Cortex can absorb,” he said.
He said he prefers a pars plana posterior vitrectomy approach for removing lens material from the vitreous. The surgeon should have regular experience performing pars plana vitrectomy, and the essential tools include a wide-angle viewing system, an endoilluminator, a vitrector with the highest cutting rate available, at least 5,000 cpm, and a fragmenter instead of a phaco probe. There needs to be good visibility with a clear central cornea and reasonable dilation. Also, he said the phaco wound needs to be sutured to prevent iris prolapse and other issues.
“It is better to infuse through a side port. If you need to add one, always infuse to the side port and never through the phaco wound. This is very important,” Charles said.
He said it is necessary to remove all vitreous before removing any lens material.
In performing anterior vitrectomy, Charles said to never use a cellulose sponge to remove or test any vitreous.
“Lifting to cut and wicking cause marked vitreoretinal traction,” he said.
He also said that the infusion bottle should be set to a low height for lower pressure.
“Do not sweep the wound. This causes marked instantaneous peripheral retinal traction,” he said.
Charles recommended triamcinolone particulate marking.
Cutting requirements are the same for anterior vitrectomy as posterior vitrectomy, and surgeons should use the highest cutting rate possible.
As for the wound construction in pars plana vitrectomy, the best option is a straight-in, wound-sutured construction.
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Charles S. Management of capsule rupture during cataract surgery. Presented at: Kiawah Eye; June 2-4, 2022; Kiawah Island, S.C.
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