Dr Somdutt Prasad also known as Dr Som Prasad shows the process of conducting anterior vitrectomy during APACRS 2015.

1. How to do an anterior vitrectomy
MC04: Vitreoretinal update
Dr Somdutt Prasad
MS (Cal) FRCS (Edin) FRCOphth (Lond) FACS (USA)
Consultant Eye Surgeon & Retina Specialist
AMRI Hospitals & i4vision, Kolkata, India
sprasad@rcsed.ac.uk +91 9830507754
www.somduttprasad.com

2. No financial interest

3. Outline
• Bimanual Anterior Vitrectomy
• Dry Anterior Vitrectomy
• Pars plana anterior vitrectomy
• Optional manoeuvres
– Optic Capture
– PC tear → PCCC
• Finishing & Post Operative plan

4. When the PC tears...
• Stop US and aspiration
• Keep irrigation on (position 1)
• Avoid AC collapse

6. Bimanual Anterior Vitrectomy
• Most useful technique
• Separate irrigation and
aspiration/cutting
– Irrigation directed anteriorly
– Cutter clears presenting vitreous;
placed through PC tear pointed
posterior and vitreous

7. Machine Paratmeters
• Low bottle height
• High cut rate 1500-2000/min
• Aspiration 150-250 mmHG
• When dealing with lens matter clear
of vitreous drop cut rate to 300/min

8. Machine settings
• B&L Millenium / Stellaris
– Dual Linear
• Alcon / others
– Irr – Cut – Asp (for Vit)
– Irr – Asp – Cut (for lens matter)

10. Dry Anterior Vitrectomy
• Usually suitable if small amount of
vitreous presenting towards end of
procedure.
• High cut rate 500-750/min
• Refill with visco if AC shallows

16. Single pars plana port

20. Optic Capture

24. PC tear → PCCC
• Only in very select circumstances
– Small, central PC tear
• Do not compromise anterior capsule
whilst doing fancy manoeuvres with
PC !

26. Surgical technique
• Stay in control
• Avoid AC collapse
• Consider: PC tear → PCCC
• Deal with vitreous
– Triamcinolone
• IOL implant
– Sulcus – IOL power
– optic capture
– If PCCC achieved: in the bag

27. Surgical Technique
• Shut pupil
– Watch for peaks
– Reinstill triamcinolone
• Low threshold for wound suture

28. Post operative
• Treat IOP
– Avoid aqueous release
• Treat inflammation
– Kenalog granules may appear in AC:
pseudohypopyon
• Detailed fundus evaluation before
discharge

31. Excellent visual outcomes,
even with complication
occuring
sprasad@rcsed.ac.uk

32. Dr Somdutt Prasad
Thank You
www.somduttprasad.com