A New Concept of Managing Vitreous Loss for the Anterior Segment Surgeon: A One Step Phako Customized Anterior Chamber Maintainer Designed to Fit Through the Phako Wound Combined With Single Port Pars Plana 25 Gauge Vitrectomy

Abstract

Purpose: : To describe an improved technique for the pars plana management of vitreous loss for the anterior segment surgeon which requires no other incisions than the original phako wound site and the insertion of a single 25 gauge cannula.

Methods: : A phako customized anterior chamber maintainer was designed to be inserted immediately into the phako wound once vitreous loss is recognized. The anterior chamber maintainer has tubing for the infusion of balanced salt solution. It is made of silicone with a cross section that mimics the incision, allowing it to conform to the incision. It has a height of 0.76 mm in the center which necks down as it moves to the periphery, forming a V on each end. Moving from front to back, there are a series of four steps 1 mm long with corresponding widths of 2.5mm, 3mm, 3.5mm, and 4mm. This allows it to fit phako wound widths ranging from 2.5 mm to 3.5 mm.

Results: : A video will be shown. Immediate closure of the open eye, deepening of the anterior chamber and restoration of intraocular pressure can be achieved by the single step of inserting the phako customized anterior chamber maintainer into the main phako wound once vitreous loss is recognized. Once the eye is pressurized, a 25 gauge cannula is inserted transconjunctivally through the pars plana. A high speed 25 gauge vitreous cutter is then inserted through the cannula and pars plana vitrectomy pulls vitreous from the anterior chamber. Residual cortical material is removed by the vitreous cutter. At the conclusion of the vitrectomy the cannula and the phako customized anterior chamber maintainer are removed and cataract surgery is resumed.

Conclusions: : This novel approach to vitreous loss allows immediate control of the open wound with a single step. We believe that pars plana vitrectomy results in more complete removal of vitreous and eliminates vitreous remaining in the anterior chamber by pulling the anterior vitreous out posteriorly. The transconjunctival cannula protects the vitreous base and peripheral retina from trauma and obviates the need for suturing. Anterior segment surgeons should consider the use of the phako customized anterior chamber maintainer and 25 gauge pars plana vitrectomy because it offers a safer, faster and easier approach to management of vitreous loss with a possible reduction of cystoid macular edema.

Keywords: vitreoretinal surgery • treatment outcomes of cataract surgery • small incision cataract surgery