This document provides an overview of vitrectomy principles and techniques. It discusses the history and evolution of vitrectomy surgery. It covers surgical anatomy, the main aims of vitrectomy, components of vitrectomy machines and their functions. It describes techniques for sclerotomies, vitreous cutters, infusion cannulas and viewing systems. It outlines the basic steps of a closed vitrectomy procedure and discusses adjunctive procedures like air-fluid exchange and use of perfluorocarbon liquids, silicone oil and gases. Recent advances discussed include 25-gauge vitrectomy and endoscope-assisted surgery.

1. VITRECTOMY PRINCIPLES
DR.SHAH-NOOR HASSAN
FCPS,FRCS(Glasgow)

2. Introduction
 1968-open sky vitrectomy-KASNER
 1971-closed system vitrectomy-modern
pars plana surgery -MACHEMER
 Bimanual vitrectomy-O’MALLEY
 CHARLES ,SCHEPENS,PEYMAN-
instrumentation&surgical techniques.

3. Surgical Anatomy

4. MUSCLE INSERTIONS

5.  Pars Plicata-2.5 MM
 Pars Plana –3-5MM
 Ora –5-7MM From Limbus
 Vitreous Base-2-6mm wide zone
straddling the ora, extending 2-3mm
posterior to it .

7. Main Aims
 Clearing the media & access to
diseased retina,space for
int.tamponade
 Retinal manipulation & reattachment
 Release of v-r traction
 Removal of tissue or foreign material &
to obtain vit. biopsy.

8. Components
 Vitreous cutter and aspiration
 Infusion canula
 Light pipe
Other important adjuncts

9. Components On Machine
 Dual illumination module.
 Diathermy module.
 Air module.
 Vitrectomy module with viscous fluid
inj(VFI).
 Fragmentation module.
 Irrigation/Aspiration module, also
Viscous fluid extraction.

10. Viewing system
 Conventional
 Wide angle

11. Conventional
 Plano concave lenses
 Hand held contact
lenses,placed on a
ring,self stabilizing
 Small
field,nonmagnified
 Additional lenses reqd
 High
resolution,excellent
stereopsis

12. Wide Angle System
 Contact
 Non Contact
Stereroscopic Diagonal Invertor reqd

13. Wide Angle visualisation Systems

14. LENS MAG FIELD USE
PLANO
CONCAVE FLAT
1.0 20* POSTERIOR
POLE
,CENTRAL
VITREOUS
PRISM LENS 1.0 20* MIDPERIPHERA
L FUNDUS AND
VITREOUS
SUPER
MACULA (V)
1.03 64*-77* POSTERIOR
POLE
,CENTRAL
VITREOUS
MINI QUAD 0.71 106*-127* UPTO ORA
LANDERS
WIDEFIELD
0.38 130*-146* UPTO ORA
LANDERS
EQUATORIAL
0.65 101*-131* GOOD UPTO
EQUATOR

15. Vitreous Cutter
 Presence of outer
fixed tube and an
opening thru’ which
vit. is aspirated.
 Inner tip slides
across inner Port. of
opening thus cutting
the vitreous
Eg.Guillotine,Rotatio
n,Oscillation.
 Safe to use low
suction,high cut rate

16. Vitreous Cutter

17. Aspiration
 Device based on venturi principle creates
vacuum used to provide aspiration
 The venturi has inlet for compressed air
& uses the energy from air to produce a
vacuum.

19. Light Pipe/Endoilluminator
 Halogen Bulb
 Endo illum.
Probe-20 gauge
(0.9mm) Fibre
optic cable
 Yellow light and
White light.

20. Infusion Canula

21. Intraocular Irrigating Solution
 CRITERIA–should be sterile,isotonic and
which constitute near those of normal
ocular fluid and with a balanced pH.
 Mixture of GBR(glutathione, bicarbonate
and ringer lactate).
 BSSPlus with similar comb.
 Lens opacification in diabetic pt.
Advocated- Glucose fortified BSS Plus
 Regular BSS Plus for non diabetic pt.

22. Before You Begin
 Inspection and testing of cutter for
cutting and aspiration
 Flushing of air bubble from system &
infusion canula.
 Testing of fiberoptic probe/light pipe.
 Adjustment of infusion bottle height.

23. Making Sclerotomies
 Peritomy
 Hemostasis
 Location
 Instruments
 Technique and direction

24. Sclerotomy for Infusion canula
FIRST TO GO IN ,LAST TO COME OUT
 Length of canula
 Site
 Location
 Anchoring sutures
 Sclerotomy

26. Checking for canula tip
 APHAKIC/PSEUDOPHAKIC
 PHAKIC

28. Basic closed Vitrectomy
 Confirm infusion canula in and start fluid
 Insert light pipe and cutter
 Cutting and suction activated by cutter
 Viewing system and parameters of suction
and cutting vary depending on a given
condition and plane of working
 Basic eye movements are made by
exerting equal forces with 2 instr. in same
direction.
 In Phakics imp. to avoid possible damage
to the lens.

29. Simple Vitrectomy
 Core vitrectomy
 Peripheral vitrectomy
 Removal of posterior hyaloid
 Inspection of peripheral retina
 Closure

30. Core vitrectomy
 Mid vitreous
 Instruments held steady
 Advance posteriorly

31. Peripheral Vitrectomy
 Cutter position
 Scleral depression
 High speed cutting

32. Removal of posterior hyaloid
 Engaged in peripapillary region
 Soft tipped extrusion canula
 Signs of engagement
 Technique
 MVR / Pick

33. Inspection of peripheral retina
 To ascertain no tears
 Inspect vulnerable areas
 SOS Cryo/Laser

34. Closure
 Excision of any prolapsed vitreous
 Suturing ports(infusion canula last to
come out)
 Suturing conjunctiva

35. Other adjunctive procedures
 Lensectomy –opacification /PVR
/trauma /IOFB
 Air fluid exchange
 PFCL/Silicone oil /gases
 Endolaser / endodiathermy

36. Air fluid exchange
 Air via infusion canula
(pump)
 Active aspiration
 Passive aspiration
 Removal of SRF

37. Use of PFCL
 Giant retinal tear
 PVR
 Dislocated nucleus / dropped nucleus

38. Use of silicone oil
 PVR
 Diabetic vitrectomies
For prolonged tamponade

39. Use of gases C3f8 Sf6
 Pneumoretinopexy
 Tamponade

40. Recent advances
 25 G vitrectomy –transconjunctival,sutureless
Tried in less complicated cases like
ERM /Diabetic macular edema/ macular hole
/persistent vitreous haem
 4-port vitrectomy(both hands actively
functioning with help of chandelier system)
 23 G
 Endoscope assisted
 OFFICE system

41. Write the OT notes of the following situations
 Recent Total RRD in a 60 year old
patient
 Recent TRD in a diabetic patient
 Fresh Vit. Hg in a 35 yr old male patient
 Fresh Rd from 2 to 4 o clock in a young
patient

42. Thank You