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Yoreh Barak, MD, Lana Rifkin, MD, Omar Saleh, MD, Shlomit Schaal, MD, PhD
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Shlomit Schaal, MD, PhD; Omar Saleh, MD; Yoreh Barak, MD; and Lana Rifkin, MD, present the removal of retained lens fragments using a 25 gauge vitrectomy technique. A 62-year-old, Caucasian female underwent complicated cataract surgery resulting in large lens fragments in the vitreous cavity and a sulcus positioned IOL. On the following day, a 25 gauge vitrectomy and removal of lens fragments was performed. Anterior vitrectomy and releasing of lens fragments from vitreous attachments is demonstrated using 2500 cuts per minute (cpm) and 500 mmHg vacuum. Lensectomy is performed using 100 cpm, 600mmHg vacuum and a duty cycle set on "core" setting (Constellation, Alcon), which means that most of the cycle the vitrectome is preferentially open. All lens fragments are easily removed in this manner. The surgery ends with 360 degree endolaser photocoagulation and fluid air exchange.
Posted: 3/08/2012
Yoreh Barak, MD, Lana Rifkin, MD, Omar Saleh, MD, Shlomit Schaal, MD, PhD
Shlomit Schaal, MD, PhD; Omar Saleh, MD; Yoreh Barak, MD; and Lana Rifkin, MD, present the removal of retained lens fragments using a 25 gauge vitrectomy technique. A 62-year-old, Caucasian female underwent complicated cataract surgery resulting in large lens fragments in the vitreous cavity and a sulcus positioned IOL. On the following day, a 25 gauge vitrectomy and removal of lens fragments was performed. Anterior vitrectomy and releasing of lens fragments from vitreous attachments is demonstrated using 2500 cuts per minute (cpm) and 500 mmHg vacuum. Lensectomy is performed using 100 cpm, 600mmHg vacuum and a duty cycle set on "core" setting (Constellation, Alcon), which means that most of the cycle the vitrectome is preferentially open. All lens fragments are easily removed in this manner. The surgery ends with 360 degree endolaser photocoagulation and fluid air exchange.
Posted: 3/08/2012
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Shlomit Schaal
13 years ago
Thank you for your comment. I also use chandelier and 360 degree laser for all my retinal detachment small gauge surgeries. 29G chandeliers are now available.
Paolo Rossini
13 years ago
I totally agree with chandelier use and in particular with 360 degree peripheral endolaser, that I perform routinely for all my VR surgeries.
SHALABH SINHA
13 years ago
Have you placed a chandelier? Why 360 degrees laser? Breaks can be seen and then lasered, this 360 laser is hardly required. I have seen holes forming because of the very small and intense laser burn, with subsequent RD.
Shlomit Schaal
13 years ago
Dear Dr. Shalabh, Thank you very much for your comment. Yes, I have used a chandelier in this case. Please refer to the article below regarding the reduction of RRD rates post viterctomy and lensectomy by using prophylactic endolaser photocoagulation. J Cataract Refract Surg. 2009 Mar; vol. 35(3) pp. 491-5 Intraoperative retinal detachment prophylaxis in vitrectomy for retained cataract fragments. Morris RE, Shere JL, Witherspoon CD, Segal ZK, Tehranchi L, Kuhn F, Sapp M