RESEARCH ARTICLE


Intraoperative Switch to a Temporal Surgical Approach in 23- and 25-Gauge Microcannula-Based Sutureless Transconjunctival Vitrectomy



Szilárd Kiss1, 2, Demetrios Vavvas*, 2
1 Retina Service, Weill Cornell Medical College, Department of Ophthalmology, 1305 York Ave, 11th Floor, New York, New York 10021, USA
2 Retina Service, Massachusetts Eye and Ear Infirmary, Harvard Medical School Department of Ophthalmology, 243 Charles St., Boston, Massachusetts 02114, USA


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© Kiss and Vavvas; Licensee Bentham Open.

open-access license: This is an open access article licensed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/), which permits unrestricted, non-commercial use, distribution and reproduction in any medium, provided the work is properly cited.

* Address correspondence to this author at the Retina Service, Massachusetts Eye and Ear Infirmary, Harvard Medical School Department of Ophthalmology, 243 Charles St., Boston, Massachusetts 02114, USA; Tel: (617) 573-6874; Fax: (617) 573-3678; E-mail: demetrios_vavvas@meei.harvard.edu


Abstract

Purpose:

To illustrate a surgical method in which the infusion port during a three-port pars plana vitrectomy is moved intraoperatively from the traditional infra-temporal location and placed supra-nasally, thus permitting a temporal surgical approach to better tackle superior and inferior vitreoretinal pathology.

Methods:

Description of surgical technique.

Results:

When the location of the vitreoretinal pathology and/or the patient's anatomy prevents adequate visualization or surgical access and/or the instrument flexibility precludes sufficient maneuvering of the eyeball, a temporal approach to the vitrectomy may be employed by utilizing the interchangeable microcannulas of 23- and 25-gauge vitrectomy systems. The infusion port is dis-inserted from the traditional infra-temporal microcannula and reaffixed in the supra-nasal microcannula. The surgeon, the operating microscope, and the foot pedals are then adjusted to a temporal orientation, and the instruments inserted through the temporally placed microcannulas.

Conclusions:

The flexibility of interchangeable microcannulas in 23- and 25-gauge PPV systems permits intraoperative switching between superior and temporal surgical sites to better manage posterior segment pathology.

Keywords: Vitrectomy, intraoperative switch, vitreoretinal, transconjunctival, microcannula.