Surgical Detachment of the Anterior Hyaloid Membrane From the Posterior Lens Capsule

Abstract

To describe 2 techniques facilitating the potentially challenging removal of the anterior hyaloid during phakic pars plana vitrectomy. Methods: Observational surgical series describing the 2 techniques. The hydrodissection technique applies an injection of balanced salt solution into the anterior chamber to displace the anterior hyaloid posteriorly for facile removal. The bubble technique is a novel method that utilizes air bubbles to visualize the anterior vitreous, allowing closer placement of the vitrectomy cutter to facilitate anterior hyaloid removal. Results: Both techniques were successful for the safe, efficient removal of the anterior vitreous. Conclusion: Removal of the anterior vitreous in a phakic patient is a difficult maneuver which may lead to potential damage to the lens. The hydrodissection and bubble techniques may be used to efficiently and safely remove the anterior vitreous.

Endodiathermy assisted vitreous base and anterior hyaloid visualization during vitrectomy for rhegmatogenous retinal detachment

“…The anterior hyaloid face behind the posterior lens capsule is difficult to be visualized. Different techniques were described to remove the anterior hyaloid including the use of the vitrectomy probe to pull on the anterior hyaloid, 14 but this traction may induce iatrogenic peripheral retinal breaks. Balanced saline solution (BSS) was proposed to be forcibly injected into the anterior chamber near the pupillary margin to separate the anterior hyaloid membrane.…”

“…Balanced saline solution (BSS) was proposed to be forcibly injected into the anterior chamber near the pupillary margin to separate the anterior hyaloid membrane. 14 However, the generated tension on the lens zonules increases the risk of lens subluxation, in addition to the difficulty to assure complete anterior hyaloid dissection. Injection of air bubbles into the vitreous cavity has been shown to improve visualization of the anterior hyaloid, however, it is rapidly aspirated once anterior hyaloid started to be removed.…”

Anterior hyaloid membrane dissection using the conventional surgical microscope: a novel surgical approach in 2 patients

“…Previous microscopic techniques described to remove the anterior hyaloid include using the vitrector tip to apply manual posterior traction on the AHM [12], which may increase the risk of inducing iatrogenic retinal breaks or detachment. In addition, the injection of small air bubbles into the vitreous cavity behind the AHM may provide an estimate of the posterior lens capsule border, but does not eliminate the mechanical posterior traction induced by the vitrector tip on the anterior vitreous and possibly the lens zonules.…”

“…Forceful injection of balanced saline solution (BSS) into the anterior chamber near the pupillary margin to dissect the anterior hyaloid membrane is an established microscopic technique [12]. However, the generated tension on the lens zonules cannot be eliminated and may increase the risk of lens subluxation in patients with pseudoexfoliation syndrome or weak zonules.…”