Posters

Vitrector irrigation aspiration in a PC rent: a novel way of managing PCR with vitreous prolapse with cortical matter in the bag

Poster Details

First Author: S. Chaudhary INDIA

Co Author(s):    A. Pandey   S. Jindal                 

Abstract Details

Purpose:

Once vitreous presents through a PCR, and there is cortical matter in the bag, the usual approach is to do a vitrectomy, open the bag with visco-elastic, followed by dry cortex peeling and aspiration with a cannula. If the vitreous presents again, the whole cycle has to be repeated. Visco and cortical matter often drop into the vitreous, necessitating a referral to a retina specialist. Taking a cue from retina surgeons, we have developed a novel way of cortical clean-up which is highly effective, requires no visco, and minimizes risk of cortex falling in the vitreous

Setting:

Eye7 hospital, New Delhi, India

Methods:

23 gauge Trochar cannula is passed through the limbus with separate low height bottle to maintain chamber stability. 23 gauge vitrector through side port removes visible vitreous, and is then moved to the cortex. The cutter is placed on I-A-Cut mode with flow rate of 20 and a vacuum of 250mmhg. In foot pedal position 2, aspiration is used to hold the cortex and tease it out of the bag and then foot pedal 3 activates the cutter and rapidly cuts and sucks the cortical matter with any attached vitreous, keeping the working area free of vitreous

Results:

23 gauge Trochar cannula’s piercing mechanism is effective in entering the eye with a PC Rent. Low bottle height maintains chamber stability without turbulence. This prevents vitreous hydration and fresh prolapse in AC. Triamcinolone tinged vitreous is easily removed in absence of AC turbulence. With moderately high vacuum, the cortex teased out of the bag sticks to the cutter tip till the cutter activation removes it. This prevents cortex from falling in vitreous cavity. Since no visco-elastic is used, the risk of visco falling in the vitreous cavity with subsequent raised IOP and iritis is avoided.

Conclusions:

This novel technique involves minimal manipulation in the AC after a PC Rent is discovered. Once the AC maintainer is set, the cortical clean-up is quick with the advantage of avoiding troublesome vitreous and cortex–vitreous mix. Vitreous traction risk as seen in other techniques is completely avoided. Some residual epinuclear matter can also be removed with this technique. A foldable IOL can be injected in this stable AC without the need of visco-elastic or an air cushion. Clearer cornea’s are seen on day one

Financial Disclosure:

NONE