Vitrectomy

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Here we oresent in short the basics of vitrectomy, machine and procedure, indications and complications.

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Vitrectomy

  1. 1. VITRECTOMY<br />Dr. Ankit Punjabi<br />P.G. Ophth, Dept Of Ophthalmology<br />K.I.M.S., Hospital,<br />Bangalore<br />Email: drankitalways@gmail.com<br />
  2. 2. INTRODUCTION<br />2ND most common intraocular surgery<br />Until 1960’s : Don’t Violate Vitreous<br />1971: Machemer – 1st planned vitrectomy<br />1972: O’Malley & Heinz – 3-port vitrectomy<br />Recently : 23 and 25-gauge vitrectomy<br />
  3. 3. APPLICATIONS<br />Removal of vitreous opacity<br />Removal of IOFB / dislocated lens / IOL<br />Repair of RD or retinal Distortion<br />Control of NV of iris and retina<br />
  4. 4. INDICATIONS<br />RETINAL DETACHMENT<br />DIABETIC RETINOPATHY<br />TRAUMA<br />MACULAR SURGERY<br />PEDIATRIC RETINAL DISORDERS<br />TUMORS<br />COMPLICATED ANT SEGMENT SURGERY<br />UVEITIS<br />
  5. 5. Retinal Detachment<br />RD with Proliferative Vitreoretinopathy<br />Giant retinal tears<br />RD with posterior retinal breaks<br />Selected primary RD<br />
  6. 6. Diabetic Retinopathy<br />Non-clearing repeated VH<br />TRD<br />Combined RD<br />Progressive fibrovascular proliferation<br />Macular distortion by fibrovascular proliferation<br />Macular Edema from taut posterior hyaloid<br />
  7. 7. Trauma<br />Traumatic cataract / dislocated lens<br />Posterior penetration injuries with VH/RD<br />IOFB<br />Subretinal membranes / hemorrhage<br />Traumatic macular holes<br />
  8. 8. Macular Surgery<br />Macular pucker<br />Macular hole<br />CNV<br />Massive subretinal hemorrhage<br />VMT syndrome<br />Macular translocation<br />Transplantation of Photoreceptors or RPE<br />
  9. 9. Pediatric Retinal Disorders<br />ROP<br />PHPV<br />Familial exudativevitreoretinopathy<br />Giant retinal dialysis/ tears<br />Juvenile retinoschisis<br />Juvenile RA<br />RD secondary to choroidal coloboma<br />RD in “morning glory” syndrome / optic disc coloboma<br />
  10. 10. Tumors<br />Choroidal melanoma<br />Complications of retinal angiomatosis<br />Combined hamartoma of retina & RPE<br />Intraocular lymphoma<br />Diagnostic vitrectomy<br />
  11. 11. Complicated Ant Segment Surgery<br />Dislocated lens fragments<br />Dislocated IOL<br />Aphakic / pseudophakic CME<br />Endophthlamitis<br />Choroidal hemorrhage<br />Anesthetic needle perforation<br />
  12. 12. Uveitis<br />Viral retinitis<br />Intraocular infections<br />Ophthalmomyosis<br />Inflammatory:<br />Bechet’s Disease, sarcoidosis, uveal effusion syndrome<br />Pars planitis<br />Whipple’s disease<br />Hypotony<br />
  13. 13. VITREO-RETINAL UNIT SETUP<br />
  14. 14. MANPOWER<br />
  15. 15.
  16. 16.
  17. 17.
  18. 18.
  19. 19. INSTRUMENTATION<br />VITRECTOMY SYSTEMS<br />3-port systems<br />Combined-function instruments<br />VISUALIZATION<br />Hand-held irrigating contact lens<br />Floating of sutured contact lens<br />Wide-angle lens<br />Keratoprosthesis<br />Operating microscope<br />Intraocular endoscope<br />
  20. 20. ILLUMINATION<br />Fibreoptic light pipe<br />Fibreoptic light sleeve<br />Fibreoptic light canula<br />Illumination collars<br />From microscope<br />INFUSION<br />Infusion canula<br />Infusion sleeves<br />Air pump-silicone oil pump<br />
  21. 21. INSTRUMENTS<br />Scissors<br />Forceps<br />Picks<br />Ultrasound needles for lens removal<br />Aspiration catheters<br />magnets<br />ANCILLARY INTRAVITRIAL DRUGS & AGENTS<br />Epinephrine, antibiotics, antiinflammatory, antiproliferative, tPA, hyaluronic acid, thrombin<br />
  22. 22. PHOTOCOAGULATION<br />Endophotocoagulation : endolaser / endoxenon<br />IO photocoagulation<br />Transscleral laser<br />CRYOTHERAPY<br />Transscleral / transvitreal<br />DIATHERMY<br />Transvitreal<br />Bipolar unimanual / bimanual<br />Transscleral<br />
  23. 23. SCLERAL BUCKLING ELEMENTS<br />Silicone sponges<br />Solid silicone plates<br />Silicone bands<br />TAMPONADES<br />Air<br />Long-acting gases<br />Silicone oil<br />Liquid perflourochemicals<br />
  24. 24. CYANOACRYLATE GLUE<br />TACKS ( retina and iris)<br />SUTURES (retina and iris)<br />GIANT TEAR TABLE (used in historical era)<br />
  25. 25. DORC Harmony TTC<br />Dual Fiber Optic Illumination <br />High Frequency Diathermy <br />Air-Fluid Exchange <br />Viscous Fluid Injection <br />Vitrectomy, high speed, dual linear control <br />PhacoEmulsificalion & Fragmentation, dual linear control <br />Irrigation / Aspiration & Viscous Fluid Extraction <br />DORC Dual Linear Venturi<br />
  26. 26.
  27. 27. Surgical Anatomy<br />Video<br />
  28. 28. BASIC TECHNIQUE<br />Video<br />
  29. 29. GENERAL PROCEDURE<br />
  30. 30.
  31. 31.
  32. 32.
  33. 33.
  34. 34.
  35. 35. 25-GAUGE VITRECTOMY SYSTEM<br />
  36. 36. 25-gauge system Trocars<br />
  37. 37. 25-gauge system vitreous cutters<br />
  38. 38. Xenon light source.<br />
  39. 39. The forceps, the vertical scissors,<br />and the curved scissors<br />
  40. 40. 20-gauge 23-gauge 25-gauge<br /> Forceps<br />
  41. 41. Pressure Plate<br />
  42. 42. Forceps with scale marks<br />
  43. 43. 25-gauge chandelier illumination<br />20-gauge and 25-gauge illuminated infusion cannula. Diameter is 500 & 380 um respectively<br />
  44. 44. Optical fiber-free intravitreal surgery system (OFFISS)<br />
  45. 45. Associate 2500<br />Advanced Dual System, Phaco and VitrectomyTwin Pump System, Peristaltic and VenturiBimanual Cool Phaco / M.I.C.S.High Speed Vitrectomy, 20, 23 and 25 gauge compatible<br />
  46. 46. Complication of Vitrectomy<br />Retinal breaks<br />Retinal detachment<br />Choroidal hemorrhage<br />Vitreous hemorrhage<br />Subretinal hemorrhage<br />Choroidal detachment<br />Cataract<br />Dislocation of existing intraocular lens<br />Corneal decompensation<br />Hypotomy<br />Fibrovascular growth in sclerotomy<br />
  47. 47. Endophthalmitis<br />Lid abnormalities<br />Neovasculariion of iris<br />Glaucoma<br />Anterior hyaloidfibrovascularpriliferation<br />Scleral buckle infection/extrusion<br />Anterior segment necrosis<br />Retinal vascular occlusion<br />Optic atrophy<br />
  48. 48. Thank You<br />

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