Trimanual Technique Using Assistant-Controlled Light Probe Illumination and Wide-Angle Viewing System in 23-Gauge Sutureless Vitrectomy for Diabetic Tractional Retinal Detachment

Abstract

The trimanual technique is valuable for membrane dissection in severe diabetic TRD. The optimal and dynamic illumination provided a high-quality stereoscopic view under a wide-angle viewing system. Careful coordination between a surgeon and an assistant facilitates this technique.

Comparison of 23 gauge transconjunctival releasable Suture Vitrectomy with standard 20 gauge Vitrectomy

“…Various studies have reported differing post operative hypotony rates in case of small gauge suturesless vitrectomies. 21 Despite improvements in trocar cannula designs and our better understanding of scleral entry angles, scleral wound incompetence is encountered despite massaging of wound at the end of vitrectomy. Such port leaks may lead to hypotony, infections, choroidal detachments and loss of effective tamponade.…”

Soloist performance of vitrectomy probe in proliferative diabetic retinopathy

“…Moreover, as the illumination is static, it could be insufficient for accurate recognition of the dissection planes in certain conditions. 15…”

A Review of Innovations in Rhegmatogenous Retinal Detachment Surgical Techniques

“…Although these are not the tractional membranes encountered in the eyes with diabetic tractional retinal detachment, they may be similarly difficult to peel. Two recent publications have described a four-port approach for bimanual dissection of membranes in patients with diabetic tractional retinal detachment [36, 37]. The suggested technique includes an infusion port, 2 ports used by the surgeon for bimanual manipulation, and a fourth port through which the assistant holds and controls the light source.…”