Vitreo-Retinal Dissector (VRD) for Pars Plana Vitrectomy

Abstract

Purpose: : Membrane peeling, separation of the posterior hyaloid from the retina, separation of thick membranes from the retina, internal limiting membrane peeling among other maneuvers are frequently achieved in a daily practice by means of an improvised instrument like a bent 20G needle or bent MVR blade, which with their sharp edges and angulation may cause retinal damage. Some instruments like spatulas and scrapers have been designed for this purpose. We designed a blunt miniature instrument with a window to visualize engagement of blade and the membrane before cutting with a curve plane design to insure adaptability emulating an angled microkeratome. We evaluated easy and harmless maneuvers in vitreo-retinal surgery.

Methods: : Thirty two isolated vitreo-retinal maneuvers were tested using the VRD as a portion of a surgical procedure without risking or modifying surgical plan these were performed in different pathologies like proliferative diabetic retinopathy, idiopathic epiretinal membranes and macular holes. All maneuvers were qualified as successful or not successful if the maneuver were achieved as if a regular procedure were performed.

Results: : Thirty one (97%) of all maneuvers were qualified as successful and 1 (3%) in a internal limiting membrane (ILM) peel was qualified as unsuccessful. The dissector allowed separation of posterior hyaloid from the retina in diabetic eyes, peeling membranes from the retina and ILM peeling. Blunt fine lateral edges prevented retina damage at dissection. It was helpful in finding edges of membranes and initiating the peel. The VRD engaged vitreoretinal membranes in a safe way and the window was helpful to visualize engagement of membranes.

Conclusions: : An ergonomic dissector for epiretinal membranes, posterior hyaloid and internal limiting membrane may prevent retinal damage as compared with improvised instruments from syringe needles and MVR blades.

Keywords: retinal detachment