Complete removal of the posterior hyaloid is an important procedure in vitrectomy for various vitreoretinal disorders. Although posterior vitreous detachment (PVD) can be usually induced by active aspiration of vitreous gel, it is difficult in cases where the posterior hyaloid attaches tightly to the retina, especially in minimum incision vitrectomy systems (MIVS) due to the smaller apertures of the instruments. We describe a novel technique of creating PVD without aspiration. In this method, a break in the vitreous cortex is initially made at the posterior precortical vitreous pocket using a diamond dusted membrane scraper. Once a break in the vitreous cortex is induced, the break is extended by continuing the same manipulation. Detachment of the posterior vitreous gradually progresses by the influx of irrigation fluid from the break into the space between the posterior vitreous and the retina. Subsequently, the scraper is inserted under the detached posterior hyaloid from the break in the cortical vitreous, and is lifted upward to complete the PVD. Complete PVD is confirmed by observation of the Weiss ring in front of the retina. Using this technique, PVD can be achieved in vitrectomies using MIVS, even when the posterior hyaloid attaches tightly to the retina.
Purpose: To study the necessity of prophylactic systemic steroid therapy after coaxial microincision cataract surgery (MICS) conducted in aged patients during remission of uveitis. Procedures: A total of 17 consecutive patients who underwent MICS were enrolled in this retrospective study. The median age was 73 years. MICS via a 2.2-mm incision was performed. None of the patients received systemic steroid administration after surgery. The visual acuity, intraocular pressure (IOP) and inflammation scores were recorded. Results: The mean logMAR visual acuity was significantly improved from 0.56 ± 0.58 to 0.10 ± 0.30, and the mean inflammation score was reduced from 0.20 to 0.14. Postoperative complications were recurrence of ocular inflammation in 1 eye and elevation of IOP more than 21 mm Hg in 1 eye, which were resolved by topical steroids and topical antiglaucoma medication. Conclusions: Prophylactic systemic steroid therapy after MICS may not be necessary in aged uveitis patients without posterior complications before cataract surgery.
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