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Anterior Vitrectomy Process by Dr Somdutt Prasad at APACRS 2015

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Dr Somdutt Prasad also known as Dr Som Prasad shows the process of conducting anterior vitrectomy during APACRS 2015.

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Anterior Vitrectomy Process by Dr Somdutt Prasad at APACRS 2015

  1. 1. How to do an anterior vitrectomy MC04: Vitreoretinal update Dr Somdutt Prasad MS (Cal) FRCS (Edin) FRCOphth (Lond) FACS (USA) Consultant Eye Surgeon & Retina Specialist AMRI Hospitals & i4vision, Kolkata, India sprasad@rcsed.ac.uk +91 9830507754 www.somduttprasad.com
  2. 2. No financial interest
  3. 3. Outline • Bimanual Anterior Vitrectomy • Dry Anterior Vitrectomy • Pars plana anterior vitrectomy • Optional manoeuvres – Optic Capture – PC tear → PCCC • Finishing & Post Operative plan
  4. 4. When the PC tears... • Stop US and aspiration • Keep irrigation on (position 1) • Avoid AC collapse
  5. 5. Bimanual Anterior Vitrectomy • Most useful technique • Separate irrigation and aspiration/cutting – Irrigation directed anteriorly – Cutter clears presenting vitreous; placed through PC tear pointed posterior and vitreous
  6. 6. Machine Paratmeters • Low bottle height • High cut rate 1500-2000/min • Aspiration 150-250 mmHG • When dealing with lens matter clear of vitreous drop cut rate to 300/min
  7. 7. Machine settings • B&L Millenium / Stellaris – Dual Linear • Alcon / others – Irr – Cut – Asp (for Vit) – Irr – Asp – Cut (for lens matter)
  8. 8. Dry Anterior Vitrectomy • Usually suitable if small amount of vitreous presenting towards end of procedure. • High cut rate 500-750/min • Refill with visco if AC shallows
  9. 9. Single pars plana port
  10. 10. Optic Capture
  11. 11. PC tear → PCCC • Only in very select circumstances – Small, central PC tear • Do not compromise anterior capsule whilst doing fancy manoeuvres with PC !
  12. 12. Surgical technique • Stay in control • Avoid AC collapse • Consider: PC tear → PCCC • Deal with vitreous – Triamcinolone • IOL implant – Sulcus – IOL power – optic capture – If PCCC achieved: in the bag
  13. 13. Surgical Technique • Shut pupil – Watch for peaks – Reinstill triamcinolone • Low threshold for wound suture
  14. 14. Post operative • Treat IOP – Avoid aqueous release • Treat inflammation – Kenalog granules may appear in AC: pseudohypopyon • Detailed fundus evaluation before discharge
  15. 15. Excellent visual outcomes, even with complication occuring sprasad@rcsed.ac.uk
  16. 16. Dr Somdutt Prasad Thank You www.somduttprasad.com

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