Program list

SYMPOSIUM: WEAPONS CHOICES
SECTION: Techniques and devices
Moderators: Jean-Marie Parel, Frank Koch
Sunday, September 14th, 2003 ; 14:00 - 16:00

TIPS AND TRICKS IN PVR SURGERY
Frank H.J Koch*, Panka J Singh, Boris Kacer
University Eye Clinic Frankfurt am Main - Germany

Purpose: To show devices and maneuver which facilitate PVR surgery
Material & Methods: PVR takes part in all vitreoretinal segments. Wide field observation and illumnation are suitable for surgery in the posterior and anterior segments.The Binocular Indirect OphthalmoMicroscope (BIOM) and the Multiport Illumination (MIS) system were choosen. Consequent indentation, high speed cutting, drainage through preexisting peripheral holes with soft tip extrusion needles and peripheral vitrectomy in an air filled eye belong to our routine technique.
Results: The BIOM/MIS setup together with indentation of the globe guarrantee a complete vitrectomy in the periphery and allow to safely cut residual vitreous in an air filled vitreous cavity. High speed cutting inceases the safety there. Drainage through preexisting holes limits the trauma and helps to spare heavy liquids and money.
Discussion: The setup discribed above allows to accomplish over 90% of all steps in PVR. In the very few PVR situations where high resolution observation is needed, you can choose either adjusting an adequate front lens to the BIOM and/or using dyes like ICG or Vision Blue. With the high resolution front, lens short term focal illumination together with the MIS illumination is recommended for limited periods of time when working in the macular area - with the dye we strictly avoid focal illumination because of the light toxicity still under discussion.
Take home message: With modern updated wide-field observation and illumination
devices all steps of PVR surgery can be performed successfully. Heavy liquids can be spared if experiences with soft tip extrusion needles allow to "dry out" the subretinal space. Use "high mag" lenses for surgery in the macula but avoid focal illumination after staining with ICG or VB.