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G.Y. Shah, V.A. Shah, S.K. Gupta, K.V. Chalam; Management of Vitreous Incarcerated in Sclerotomies in Phakic Eyes With a 25 Gauge Illuminated Curved Vitrector . Invest. Ophthalmol. Vis. Sci. 2005;46(13):5456.
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© ARVO (1962-2015); The Authors (2016-present)
To evaluate a new technique that allows removal of incarcerated vitreous from sclerotomy sites in both pseudophakic and phakic eyes with an illuminated 25 G curved vitrector (CV) through 20 G sclerotomy during pars plana vitrectomy.
A heat shrink tubing with internal diameter 0.05" and thickness 0.0005" was used to secure a fiber optic endoilluminator (FOE) with a 25 G curved vitrector. The shaft design: radius of curvature 19.4 mm and arc length of 25 mm based on our previous series. The diameter of illuminated vitrector is 1.0 mm (0.5 mm FOE + 0.5 mm 25 G CV). Following core vitrectomy, the surgeon replaces the conventional 20 G vitrector with the illuminated 25 G CV. The illumination on the probe illuminates the vitreous on the opposite vitreous base, while the curved design of the probe avoids crystalline lens touch. This allows the surgeon to use the other hand to depress the opposite sclera, which enables viewing of the internal sclerotomy with its surrounding vitreous through the wide angle lens system. The vitreous surrounding the internal sclerotomy opening is shaved with the vitrector. The illuminated 25 G CV is subsequently inserted through the other sclerotomies to clean the vitreous around the opposite sclerotomy. We use a self retaining infusion cannula (IC) (Levicky’s Cannula); thus while addressing the supero–nasal sclerotomy the IC is introduced through the supero–temporal sclerotomy and the illuminated CV through the infero–temporal sclerotomy to shave the vitreous on the opposite side.
Vitreous was removed completely from sclerotomy sites uneventfully. This was confirmed both on clinical examination as well as ultrasonographic examination in both pseudophakic and phakic patients.
Illuminated 25 G CV combines advantage of endoilluminator and safety of CV allowing shaving the vitreous around the sclerotomy sites in pseudophakic as well as phakic eyes through a 20–gauge sclerotomy in a safe and effective manner. It possibly prevents sclerotomy related complications such as recurrent hemorrhage due to anterior hyaloid fibrovascular proliferation and postoperative retinal detachment.
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