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Trimanual Anterior Vitrectomy: A Novel Technique to Manage Vitreous Loss during Phacoemulsification.

Taggart MG, Morshedi RG, Ambati BK - Case Rep Ophthalmol (2014)

Bottom Line: The remaining cortical material was then removed using bimanual irrigation and aspiration handpieces while the assistant surgeon inserted the vitrectomy probe through a separate 1-mm limbal incision.The vitrectomy probe was held below the plane of the posterior capsule tear, used to cut the vitreous and to provide a mechanical blockade to potentially descending lens material.While this technique involves the potentially awkward simultaneous use of 3 intraocular instruments, we believe that there are several advantages over standard bimanual anterior vitrectomy.

View Article: PubMed Central - PubMed

Affiliation: John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, and Harvey and Bernice Jones Eye Institute, University of Arkansas, Little Rock, Ark., USA.

ABSTRACT
We report 2 cases illustrating the use of a new technique to manage vitreous loss during phacoemulsification, which we have termed 'trimanual' anterior vitrectomy. In each case, after recognizing posterior capsule tear, the remaining nuclear pieces were removed with low-parameter phacoemulsification. The remaining cortical material was then removed using bimanual irrigation and aspiration handpieces while the assistant surgeon inserted the vitrectomy probe through a separate 1-mm limbal incision. The vitrectomy probe was held below the plane of the posterior capsule tear, used to cut the vitreous and to provide a mechanical blockade to potentially descending lens material. While this technique involves the potentially awkward simultaneous use of 3 intraocular instruments, we believe that there are several advantages over standard bimanual anterior vitrectomy.

No MeSH data available.


Related in: MedlinePlus

Intraoperative photograph from the operating microscope (surgeon's view). The surgeon's left hand is aspirating cortex with the aspiration handpiece, and the right hand is holding the irrigation handpiece in the anterior chamber. Superiorly (right side of the photograph), the assistant is holding the vitrectomy probe with the tip posterior to the capsule defect.
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Figure 2: Intraoperative photograph from the operating microscope (surgeon's view). The surgeon's left hand is aspirating cortex with the aspiration handpiece, and the right hand is holding the irrigation handpiece in the anterior chamber. Superiorly (right side of the photograph), the assistant is holding the vitrectomy probe with the tip posterior to the capsule defect.

Mentions: Two additional 1-mm paracentesis incisions were created at the 11:30 and 1:30 positions (positioned to be accessible to the assistant who was positioned superiorly on this left eye surgery). The irrigation handpiece (held in the surgeon's left hand) was inserted through the initial paracentesis incision at the 5:00 position, and the aspiration handpiece (held in the surgeon's right hand) was inserted through the 1:30 paracentesis. The vitrectomy probe was inserted by the assistant through the 11:30 paracentesis and held with the cutting port facing up, with the tip positioned posterior to the posterior capsule tear (fig. 2). The phacoemulsification unit was initially in cut-I/A mode, and the vitrectomy probe was used to cut any vitreous in the anterior chamber. The unit was then changed to I/A-cut mode, and the surgeon used the bimanual I/A handpieces to carefully strip the cortex from the remaining capsular bag while periodically entering foot position 3, if necessary, to cut vitreous with the vitrectomy probe. The vitrectomy probe was primarily held in its position posterior to the capsule defect and used secondarily to mechanically block any lens fragments that had the potential to descend posteriorly through the capsule defect. The vitrectomy probe was occasionally raised into the anterior chamber to cut vitreous strands engaged in the remaining cortical material.


Trimanual Anterior Vitrectomy: A Novel Technique to Manage Vitreous Loss during Phacoemulsification.

Taggart MG, Morshedi RG, Ambati BK - Case Rep Ophthalmol (2014)

Intraoperative photograph from the operating microscope (surgeon's view). The surgeon's left hand is aspirating cortex with the aspiration handpiece, and the right hand is holding the irrigation handpiece in the anterior chamber. Superiorly (right side of the photograph), the assistant is holding the vitrectomy probe with the tip posterior to the capsule defect.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4264489&req=5

Figure 2: Intraoperative photograph from the operating microscope (surgeon's view). The surgeon's left hand is aspirating cortex with the aspiration handpiece, and the right hand is holding the irrigation handpiece in the anterior chamber. Superiorly (right side of the photograph), the assistant is holding the vitrectomy probe with the tip posterior to the capsule defect.
Mentions: Two additional 1-mm paracentesis incisions were created at the 11:30 and 1:30 positions (positioned to be accessible to the assistant who was positioned superiorly on this left eye surgery). The irrigation handpiece (held in the surgeon's left hand) was inserted through the initial paracentesis incision at the 5:00 position, and the aspiration handpiece (held in the surgeon's right hand) was inserted through the 1:30 paracentesis. The vitrectomy probe was inserted by the assistant through the 11:30 paracentesis and held with the cutting port facing up, with the tip positioned posterior to the posterior capsule tear (fig. 2). The phacoemulsification unit was initially in cut-I/A mode, and the vitrectomy probe was used to cut any vitreous in the anterior chamber. The unit was then changed to I/A-cut mode, and the surgeon used the bimanual I/A handpieces to carefully strip the cortex from the remaining capsular bag while periodically entering foot position 3, if necessary, to cut vitreous with the vitrectomy probe. The vitrectomy probe was primarily held in its position posterior to the capsule defect and used secondarily to mechanically block any lens fragments that had the potential to descend posteriorly through the capsule defect. The vitrectomy probe was occasionally raised into the anterior chamber to cut vitreous strands engaged in the remaining cortical material.

Bottom Line: The remaining cortical material was then removed using bimanual irrigation and aspiration handpieces while the assistant surgeon inserted the vitrectomy probe through a separate 1-mm limbal incision.The vitrectomy probe was held below the plane of the posterior capsule tear, used to cut the vitreous and to provide a mechanical blockade to potentially descending lens material.While this technique involves the potentially awkward simultaneous use of 3 intraocular instruments, we believe that there are several advantages over standard bimanual anterior vitrectomy.

View Article: PubMed Central - PubMed

Affiliation: John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, and Harvey and Bernice Jones Eye Institute, University of Arkansas, Little Rock, Ark., USA.

ABSTRACT
We report 2 cases illustrating the use of a new technique to manage vitreous loss during phacoemulsification, which we have termed 'trimanual' anterior vitrectomy. In each case, after recognizing posterior capsule tear, the remaining nuclear pieces were removed with low-parameter phacoemulsification. The remaining cortical material was then removed using bimanual irrigation and aspiration handpieces while the assistant surgeon inserted the vitrectomy probe through a separate 1-mm limbal incision. The vitrectomy probe was held below the plane of the posterior capsule tear, used to cut the vitreous and to provide a mechanical blockade to potentially descending lens material. While this technique involves the potentially awkward simultaneous use of 3 intraocular instruments, we believe that there are several advantages over standard bimanual anterior vitrectomy.

No MeSH data available.


Related in: MedlinePlus