Vitreous management during secondary implantation

Abstract

This paper describes a microsurgical system for the management of vitreous encountered during second­ ary intraocular lens implantation. Excluded from con­ sideration are those cases in which the surgeon elects to use a mechanical vitreous cutter. Also excluded are cases in which the posterior capsule is intact after an extracapsular cataract procedure. SURGICAL TECHNIQUE After topical application of a 4% solution of pilocar­ pine and local anesthesia, a wire speculum and superi­ or rectus traction suture are inserted. The microscope is positioned. A temporal or nasal conjunctival reces­ sion of 1 mm is fashioned using scissors. A 1.5-mm stab wound is made and air or sodium hyaluronate (Healon R )1. 2 is injected to maintain anterior chamber depth. The anterior chamber is inspected and the shape and size of the pupil are carefully noted. The in­ cisionis then extended to 8 mm with scissors, in a plane 1 mm posterior to the surgical limbus. If neces­ sary, the anterior chamber is again deepened using air or Healon. A Sheets lens glide 3 is introduced across the proximal iris and into the pupillary area. Pupil movement and shape are carefully observed as the lens glide is slowly advanced across the pupil towards the opposite anterior chamber angle recess. The ap­ pearance of vitreous bands is noted under magnifica­ tion. The Sheets glide acts as a probe: the tactile sen­ sation coupled with visual clues from the position, shape, and movement of the pupil are used to identify any vitreous which lies anterior to the pupil. If vitre­ ous pathology is identified, the glide is withdrawn. A microhook is used to isolate vitreous strands and these bands are then hooked and drawn to the wound where