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Depth orientation during vitrectomy procedures

A challenge for retinal surgeons in training is related to the notion of depth of the instruments during vitrectomy procedures. In this video we discuss tips on how to increase safety by improving depth perception. This is a case of a 63-year-old male patient with vitreous hemorrhage secondary to diabetic retinopathy. The patient was pseudophakic and had already undergone panretinal photocoagulation in both eyes. The procedure indicated was 25-gauge pars plana vitrectomy assisted by Chandelier light. In cases of vitreous hemorrhage, it is important to initiate core vitrectomy with good visualization of the vitrector tip. It is recommended that the surgeon does not move the instrument too much until the core vitrectomy allows better visualization of the posterior pole. The next step involves evaluating the posterior hyaloid detachment, and the technique recommends that the surgeon turn the cut off and begin aspiration from the nasal side to the disc, increasing the vacuum while gripping the hyaloid membrane and moving the vitrector anteriorly, from the center to the periphery. A good parameter to improve the notion of depth during maneuvers in which we have to get very close to the retina is to pay attention to the shadow of the instrument. The closer you are to the retina, the shorter the distance between the tip of your instrument and its shadow. You can use this parameter not only in PVD induction but in several steps on vitrectomy procedures. It’s useful during shaving the vitreous base, membrane peeling, endocauterization, photocoagulation and specially during fluid-air exchange. During FAX, you need to keep your instrument in the liquid interface. Note that as soon as you touch the liquid, the shadow acquires a “letter i” shape, with a dot above the instrument’ shadow. So in your first vitrectomies remember to use this simple landmark and keep your instrument movements safe. Video: Filipe Lucatto MD Edition: Filipe Lucatto MD Juliana Prazeres MD Salvador 🇧🇷