Sutureless Limited Vitrectomy for Positive Vitreous Pressure in Cataract Surgery

Abstract

Abstract. A sutureless transconjunctival pars plana vitrectomy with the 25-gauge transconjunctival vitrectomy system is used to facilitate phacoemulsification in eyes with positive posterior vitreous pressure and shallow anterior chamber. Peribulbar local anesthesia is administered. In eyes with shallow anterior chamber, if an injection of a viscoelastic substance through anterior chamber paracentesis fails to deepen the anterior chamber, a limited pars plana vitrectomy is performed to remove a small amount of retro-lental vitreous (approximately 0.2 to 0.3 cc) with a 25-gauge high-speed cutter. Phacoemulsification is subsequently performed. The limited pars plana vitrectomy reduces the chances of intraoperative vitreous loss and suprachoroidal hemorrhage. It also increases the anterior chamber depth, facilitates intraoperative steps such as pupil stretching and capsulorhexis, and results in a phacoemulsification procedure that is less complex and safer. [Ophthalmic Surg Lasers Imaging 2005;36:518-522.]

25-Gauge transconjunctival sutureless vitrectomy

“…Several reports have shown that combined 25-gauge surgery with phacoemulsification and intraocular lens implantation is safe and effective, needing shorter setup time for sclerotomies and causing less postoperative ocular irritation [25 ,26,27]. In cases with a shallow anterior chamber or positive vitreous pressure, limited 25-gauge PPV can be used to remove retrolental vitreous to facilitate cataract extraction [28]. When there is posterior capsular rupture with vitreous loss, 25-gauge PPV can be used to clear the anterior chamber of vitreous and perform anterior vitrectomy [29].…”

Retrospective Study of Vitreous Tap Technique Using Needle Aspiration for Management of Shallow Anterior Chamber during Phacoemulsification

“…Intraoperative uses of a cohesive ophthalmic viscoelastic device (OVD) [14] or an anterior chamber maintainer [1] are also helpful methods.…”

Cataract surgery in small adult eyes

“…Previously described prophylactic measures include: limited 1-port pars plana anterior vitrectomy, to deepen the anterior chamber15; preoperative acetazolamide and oral steroidal treatment during the 24 h preceding surgery, to reduce the risk of intraoperative and postoperative uveal effusion syndrome16; preoperative intravenous administration of Mannitol 20%, to maximise the anterior chamber depth9 17; and scleral decompression, with a view to preventing the risk of exudative retinal detachment secondary to uveal effusion 18…”