1347: resident anterior vitrectomy

Uday Devgan MD, ,

This video was anonymously sent in by a resident in training who has done about 30 prior cataract surgeries. We are reviewing it because there are some very important learning points. The first is that the posterior capsule can easily be punctured by the phaco tip in cases where the nucleus is softer than anticipated and too much ultrasonic energy is applied. We also see the phaco tip puncturing the posterior capsule when a groove is being sculpted into the nucleus.

Since the cataract has a rounded posterior capsule, we need to follow a more curved path when sculpting a groove. The center of the groove is deeper than the periphery. This is the correct path.
Beginning surgeons tend to sculpt a more linear groove and that puts the eye at risk for a posterior capsular rupture.

Another important learning point from this video is to avoid using the main phaco incision to perform an anterior vitrectomy. This incision is too big and it will leak too much. This anterior chamber instability will allow more vitreous to prolapse. You will have better results by making an additional paracentesis incision to perform the bimanual 23g anterior vitrectomy.

click to learn from this resident case of capsule rupture and anterior vitrectomy:

link here

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Published by Uday Devgan MD

Professor Uday Devgan MD is a Los Angeles Cataract Surgeon who authors CataractCoach.com to teach the best techniques of Cataract Surgery to Eye Surgeons from around the world.