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Advances in Retinal Surgery
Jamin Brown, MD Retina Vitreous Surgeons of CNY December 6th, 2014
Outline o Review 3-Port Vitrectomy o Advances
o Small Gauge Surgery o Valved Cannulas o Vitrectomy cutter design o Fluidics
o Changing management o Future Directions
3 - Port Vitrectomy
20-Gauge Opening
Small Gauge Opening
Valved Cannulas o!Increases efficiency- no plugs o!Increased self sufficiency o!Optimal IOP control
o!Lower risk of hypotony
Stable Operative Environment
Vitrectomy Cutters o!Port position - moved toward tip
o!serve as multifunctional tools o!Forceps, Backflush
o!closer shave o!membrane dissection
Traditional Scissor based Dissection
Vitrectomy Cutter Dissection
Vitrectomy Cutter Dissection
Improved Fluidics: Cutter Speed o! Vitrectomy cutter = Guillotine cutter o! Increase cut rate decreases retinal motion
o! Stable operating environment o! decreases retinal tears
Improved Fluidics: Cutter Design o!Conventional
o!Port closed pneumatically, opened via spring
o!Dual Pneumatic drive o!Port is both opened/closed pneumatically o!Allows for control of how much time port open o!Allows for control of flow
Conventional Modern
Fluidics: Retinal Stability
Modern Vitrectomy Surgery Ø Advantages
Ø More Efficient Ø Improved fluidics Ø Reduced opening/closing times
Ø Safer Ø Decrease incidence of retinal breaks
Ø Increased patient comfort Ø Faster visual recovery Ø Less corneal topography changes Ø Reduced intraocular inflammation
Changing Management
o!Retinal Detachments o!Vitrectomy vs. Scleral Buckle vs.
Pneumatic retinopexy o!They all work
o!Lower Initial success with pneumatic o!(65% vs 90+%)
o!Final anatomic success rates 98-100%
Retinal Detachments
o!Multitude of factors affect choice o!Trend toward more Vitrectomies
o!Improved optics, instrumentation, and light sources
o!Improved safety and efficacy o!Fewer complications than with SB o!Main risk is cataract
Retinal Detachments Retinal Detachments
Schaal S, Sherman MP, Barr CC, Kaplan HJ. Primary retinal detachment repair: comparison of 1-year outcomes of four surgical techniques. Retina. 2011 Sep;31(8):1500-4.
RRD Repair using Vitrectomy
Retinal Detachments o!Scleral Buckle
o!Young Phakic eyes o!No PVD
o!Pneumatic Retinopexy o!Select case
o!Single superior tear
o!Vitrectomy o!Pseudophakic eyes o!PVD
Future Directions: Smaller Faster o!Decreased cutter size
o!27 Gauge and smaller…
o!Increased cutter speed o!Twin Duty Cycle Cutters
o!16,000 cpm effective rate
Conclusions
o Advances in Technology o Improved Instruments o Improved Fluidics
o Improves Outcomes o More Efficient o Safer o More comfortable patient
experience
RRD Repair using Vitrectomy
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