Ce diaporama a bien été signalé.
Nous utilisons votre profil LinkedIn et vos données d’activité pour vous proposer des publicités personnalisées et pertinentes. Vous pouvez changer vos préférences de publicités à tout moment.
How to do an anterior vitrectomy
MC04: Vitreoretinal update
Dr Somdutt Prasad
MS (Cal) FRCS (Edin) FRCOphth (Lond) FACS (U...
No financial interest
Outline
• Bimanual Anterior Vitrectomy
• Dry Anterior Vitrectomy
• Pars plana anterior vitrectomy
• Optional manoeuvres
– ...
When the PC tears...
• Stop US and aspiration
• Keep irrigation on (position 1)
• Avoid AC collapse
Bimanual Anterior Vitrectomy
• Most useful technique
• Separate irrigation and
aspiration/cutting
– Irrigation directed an...
Machine Paratmeters
• Low bottle height
• High cut rate 1500-2000/min
• Aspiration 150-250 mmHG
• When dealing with lens m...
Machine settings
• B&L Millenium / Stellaris
– Dual Linear
• Alcon / others
– Irr – Cut – Asp (for Vit)
– Irr – Asp – Cut ...
Dry Anterior Vitrectomy
• Usually suitable if small amount of
vitreous presenting towards end of
procedure.
• High cut rat...
Single pars plana port
Optic Capture
PC tear → PCCC
• Only in very select circumstances
– Small, central PC tear
• Do not compromise anterior capsule
whilst do...
Surgical technique
• Stay in control
• Avoid AC collapse
• Consider: PC tear → PCCC
• Deal with vitreous
– Triamcinolone
•...
Surgical Technique
• Shut pupil
– Watch for peaks
– Reinstill triamcinolone
• Low threshold for wound suture
Post operative
• Treat IOP
– Avoid aqueous release
• Treat inflammation
– Kenalog granules may appear in AC:
pseudohypopyo...
Excellent visual outcomes,
even with complication
occuring
sprasad@rcsed.ac.uk
Dr Somdutt Prasad
Thank You
www.somduttprasad.com
Anterior Vitrectomy Process by Dr Somdutt Prasad at APACRS 2015
Anterior Vitrectomy Process by Dr Somdutt Prasad at APACRS 2015
Anterior Vitrectomy Process by Dr Somdutt Prasad at APACRS 2015
Anterior Vitrectomy Process by Dr Somdutt Prasad at APACRS 2015
Anterior Vitrectomy Process by Dr Somdutt Prasad at APACRS 2015
Anterior Vitrectomy Process by Dr Somdutt Prasad at APACRS 2015
Anterior Vitrectomy Process by Dr Somdutt Prasad at APACRS 2015
Anterior Vitrectomy Process by Dr Somdutt Prasad at APACRS 2015
Anterior Vitrectomy Process by Dr Somdutt Prasad at APACRS 2015
Anterior Vitrectomy Process by Dr Somdutt Prasad at APACRS 2015
Anterior Vitrectomy Process by Dr Somdutt Prasad at APACRS 2015
Anterior Vitrectomy Process by Dr Somdutt Prasad at APACRS 2015
Anterior Vitrectomy Process by Dr Somdutt Prasad at APACRS 2015
Anterior Vitrectomy Process by Dr Somdutt Prasad at APACRS 2015
Anterior Vitrectomy Process by Dr Somdutt Prasad at APACRS 2015
Anterior Vitrectomy Process by Dr Somdutt Prasad at APACRS 2015
Prochain SlideShare
Chargement dans…5
×

Anterior Vitrectomy Process by Dr Somdutt Prasad at APACRS 2015

1 258 vues

Publié le

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

Publié dans : Santé
  • Soyez le premier à commenter

Anterior Vitrectomy Process by Dr Somdutt Prasad at APACRS 2015

  1. 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. 2. No financial interest
  3. 3. Outline • Bimanual Anterior Vitrectomy • Dry Anterior Vitrectomy • Pars plana anterior vitrectomy • Optional manoeuvres – Optic Capture – PC tear → PCCC • Finishing & Post Operative plan
  4. 4. When the PC tears... • Stop US and aspiration • Keep irrigation on (position 1) • Avoid AC collapse
  5. 5. 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
  6. 6. 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
  7. 7. Machine settings • B&L Millenium / Stellaris – Dual Linear • Alcon / others – Irr – Cut – Asp (for Vit) – Irr – Asp – Cut (for lens matter)
  8. 8. 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
  9. 9. Single pars plana port
  10. 10. Optic Capture
  11. 11. PC tear → PCCC • Only in very select circumstances – Small, central PC tear • Do not compromise anterior capsule whilst doing fancy manoeuvres with PC !
  12. 12. 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
  13. 13. Surgical Technique • Shut pupil – Watch for peaks – Reinstill triamcinolone • Low threshold for wound suture
  14. 14. Post operative • Treat IOP – Avoid aqueous release • Treat inflammation – Kenalog granules may appear in AC: pseudohypopyon • Detailed fundus evaluation before discharge
  15. 15. Excellent visual outcomes, even with complication occuring sprasad@rcsed.ac.uk
  16. 16. Dr Somdutt Prasad Thank You www.somduttprasad.com

×