Visualizing the Vitreous

Abstract

Kaji et al are to be congratulated on experimenting with a method of visualizing the vitreous body in the anterior chamber.1Kaji Y. Hiraoka T. Okamoto F. et al.Visualizing the vitreous body in the anterior chamber using 11-deoxycortisol after posterior capsule rupture in an animal model.Ophthalmology. 2004; 111: 1334-1339Abstract Full Text Full Text PDF PubMed Scopus (12) Google Scholar They have attempted to improve on the method described earlier.2Burk S.E. Da Mata A.P. Snyder M.E. et al.Visualizing vitreous using Kenalog suspension.J Cataract Refract Surg. 2003; 29: 645-651Abstract Full Text Full Text PDF PubMed Scopus (108) Google Scholar Vitreous loss is the most common complication during cataract surgery; unless managed well, it leads to poor visual outcomes.3Kothari M. Thomas R. Parikh R. et al.The incidence of vitreous loss and visual outcome in patients undergoing cataract surgery in a teaching hospital.Indian J Ophthalmol. 2003; 51: 45-52PubMed Google Scholar Conversely, if adequately managed, the visual results can be similar to those of uncomplicated cases.3Kothari M. Thomas R. Parikh R. et al.The incidence of vitreous loss and visual outcome in patients undergoing cataract surgery in a teaching hospital.Indian J Ophthalmol. 2003; 51: 45-52PubMed Google Scholar India performs a large number of cataract surgeries every year, and the outcomes could possibly be better.3Kothari M. Thomas R. Parikh R. et al.The incidence of vitreous loss and visual outcome in patients undergoing cataract surgery in a teaching hospital.Indian J Ophthalmol. 2003; 51: 45-52PubMed Google Scholar, 4Thomas R. The cataract scene.Indian J Ophthalmol. 2003; 51: 209-210PubMed Google Scholar With 4 million surgeries performed in India every year, it is imperative that every vitreous loss be managed appropriately. Although visualization of the vitreous body is difficult with retroillumination, there is a technique to visualize it better and ensure its complete removal from the anterior chamber and posterior chamber. An endoilluminator can be used at the limbus (or introduced through a 20-gauge paracentesis incision) to visualize the vitreous fibrils just like in closed vitreous surgery. The vitrectomy probe is used through another paracentesis incision, and the main wound is avoided. We have used this technique for over 12 years now and can attest to its ability to visualize the vitreous and remove strands, which would otherwise be missed.3Kothari M. Thomas R. Parikh R. et al.The incidence of vitreous loss and visual outcome in patients undergoing cataract surgery in a teaching hospital.Indian J Ophthalmol. 2003; 51: 45-52PubMed Google Scholar, 5Jacob P. Thomas R. Sen S. Raju R. Anterior capsular support for posterior chamber intraocular lenses following vitreous loss in endocapsular surgery.Indian J Ophthalmol. 1993; 4: 15-16Google Scholar The injection of steroids into the vitreous has potential problems; these are being addressed, and we look forward to availability and widespread use to handle this common complication. Visualizing the vitreous body in the anterior chamber using 11-deoxycortisol after posterior capsule rupture in an animal modelOphthalmologyVol. 111Issue 7PreviewTo develop a new technique to visualize vitreous body prolapsed in the anterior chamber using 11-deoxycortisol. Full-Text PDF Author replyOphthalmologyVol. 112Issue 5PreviewWe thank Prof Thomas for his interest in our article. In the management of posterior capsule rupture and vitreous loss, visualization of the vitreous body is important for complete removal of the vitreous from the anterior chamber. Vitreous visualization is also useful to allow for minimally invasive surgical techniques to clear the vitreous, avoiding excessive surgical intervention during the management of posterior capsule rupture. Full-Text PDF