Here we oresent in short the basics of vitrectomy, machine and procedure, indications and complications.

1. VITRECTOMY Dr. Ankit Punjabi P.G. Ophth, Dept Of Ophthalmology K.I.M.S., Hospital, Bangalore Email: drankitalways@gmail.com

2. INTRODUCTION 2ND most common intraocular surgery Until 1960’s : Don’t Violate Vitreous 1971: Machemer – 1st planned vitrectomy 1972: O’Malley & Heinz – 3-port vitrectomy Recently : 23 and 25-gauge vitrectomy

3. APPLICATIONS Removal of vitreous opacity Removal of IOFB / dislocated lens / IOL Repair of RD or retinal Distortion Control of NV of iris and retina

4. INDICATIONS RETINAL DETACHMENT DIABETIC RETINOPATHY TRAUMA MACULAR SURGERY PEDIATRIC RETINAL DISORDERS TUMORS COMPLICATED ANT SEGMENT SURGERY UVEITIS

5. Retinal Detachment RD with Proliferative Vitreoretinopathy Giant retinal tears RD with posterior retinal breaks Selected primary RD

6. Diabetic Retinopathy Non-clearing repeated VH TRD Combined RD Progressive fibrovascular proliferation Macular distortion by fibrovascular proliferation Macular Edema from taut posterior hyaloid

7. Trauma Traumatic cataract / dislocated lens Posterior penetration injuries with VH/RD IOFB Subretinal membranes / hemorrhage Traumatic macular holes

8. Macular Surgery Macular pucker Macular hole CNV Massive subretinal hemorrhage VMT syndrome Macular translocation Transplantation of Photoreceptors or RPE

9. Pediatric Retinal Disorders ROP PHPV Familial exudativevitreoretinopathy Giant retinal dialysis/ tears Juvenile retinoschisis Juvenile RA RD secondary to choroidal coloboma RD in “morning glory” syndrome / optic disc coloboma

10. Tumors Choroidal melanoma Complications of retinal angiomatosis Combined hamartoma of retina & RPE Intraocular lymphoma Diagnostic vitrectomy

11. Complicated Ant Segment Surgery Dislocated lens fragments Dislocated IOL Aphakic / pseudophakic CME Endophthlamitis Choroidal hemorrhage Anesthetic needle perforation

12. Uveitis Viral retinitis Intraocular infections Ophthalmomyosis Inflammatory: Bechet’s Disease, sarcoidosis, uveal effusion syndrome Pars planitis Whipple’s disease Hypotony

13. VITREO-RETINAL UNIT SETUP

14. MANPOWER

19. INSTRUMENTATION VITRECTOMY SYSTEMS 3-port systems Combined-function instruments VISUALIZATION Hand-held irrigating contact lens Floating of sutured contact lens Wide-angle lens Keratoprosthesis Operating microscope Intraocular endoscope

20. ILLUMINATION Fibreoptic light pipe Fibreoptic light sleeve Fibreoptic light canula Illumination collars From microscope INFUSION Infusion canula Infusion sleeves Air pump-silicone oil pump

21. INSTRUMENTS Scissors Forceps Picks Ultrasound needles for lens removal Aspiration catheters magnets ANCILLARY INTRAVITRIAL DRUGS & AGENTS Epinephrine, antibiotics, antiinflammatory, antiproliferative, tPA, hyaluronic acid, thrombin

22. PHOTOCOAGULATION Endophotocoagulation : endolaser / endoxenon IO photocoagulation Transscleral laser CRYOTHERAPY Transscleral / transvitreal DIATHERMY Transvitreal Bipolar unimanual / bimanual Transscleral

23. SCLERAL BUCKLING ELEMENTS Silicone sponges Solid silicone plates Silicone bands TAMPONADES Air Long-acting gases Silicone oil Liquid perflourochemicals

24. CYANOACRYLATE GLUE TACKS ( retina and iris) SUTURES (retina and iris) GIANT TEAR TABLE (used in historical era)

25. DORC Harmony TTC Dual Fiber Optic Illumination High Frequency Diathermy Air-Fluid Exchange Viscous Fluid Injection Vitrectomy, high speed, dual linear control PhacoEmulsificalion & Fragmentation, dual linear control Irrigation / Aspiration & Viscous Fluid Extraction DORC Dual Linear Venturi

27. Surgical Anatomy Video

28. BASIC TECHNIQUE Video

29. GENERAL PROCEDURE

35. 25-GAUGE VITRECTOMY SYSTEM

36. 25-gauge system Trocars

37. 25-gauge system vitreous cutters

38. Xenon light source.

39. The forceps, the vertical scissors, and the curved scissors

40. 20-gauge 23-gauge 25-gauge Forceps

41. Pressure Plate

42. Forceps with scale marks

43. 25-gauge chandelier illumination 20-gauge and 25-gauge illuminated infusion cannula. Diameter is 500 & 380 um respectively

44. Optical fiber-free intravitreal surgery system (OFFISS)

45. Associate 2500 Advanced Dual System, Phaco and VitrectomyTwin Pump System, Peristaltic and VenturiBimanual Cool Phaco / M.I.C.S.High Speed Vitrectomy, 20, 23 and 25 gauge compatible

46. Complication of Vitrectomy Retinal breaks Retinal detachment Choroidal hemorrhage Vitreous hemorrhage Subretinal hemorrhage Choroidal detachment Cataract Dislocation of existing intraocular lens Corneal decompensation Hypotomy Fibrovascular growth in sclerotomy

47. Endophthalmitis Lid abnormalities Neovasculariion of iris Glaucoma Anterior hyaloidfibrovascularpriliferation Scleral buckle infection/extrusion Anterior segment necrosis Retinal vascular occlusion Optic atrophy

48. Thank You