Tips on: Shaving peripheral vitreous скачать в хорошем качестве

Tips on: Shaving peripheral vitreous

In this video we discuss a tip to improve visualization for shaving peripheral vitreous with scleral depression. New technologies like wide-angle viewing systems, high-speed vitreous cutters, small-incision trocar systems and chandelier lighting, enable surgeons to perform a thorough vitrectomy, which is crucial for the treatment of many vitreoretinal pathologies.  Sometimes, however, the surgeon can find difficulties to adequately visualize the peripheral vitreous, even with the use of these technologies.  In this case, a patient with Proliferative diabetic retinopathy associated with macular traction was submitted to pars plana vitrectomy. After removing all the membranes from the vascular arcades and from the optic disc, a permanent haze associated with bleeding coming from the neovascularization of the optic disc worsened the surgeon's visualization. Endocautery was used in the retinal bleeding points, and the intraocular pressure was temporally increased, but the bleeding in the papila remained. Even with the use of a Chandelier Light the surgeon didn't have adequate peripheral visualization to shave the vitreous base.  To improve the contrast and enable better visualization of the peripheral vitreous, you can use trans-scleral illumination at the point of indentation.  Some surgeons use the endoilluminator probe itself to gently depress the sclera. However, the blunt tip of the scleral depressor allows a more effective and controlled indentation. So, you can hold both instruments, the scleral depressor and the endoillumination probe together to perform trans-scleral illumination and allow a safetier peripheral shaving of the vitreous base. This technique, however, does not allow the surgeon to slide the scleral depressor how we used to do when using only this instrument. To change the position, you need first to move the scleral depressor and then positioning the endoilluminator probe in the same place.  It is a simple tip that you can use in several vitrectomy procedures when you are not comfortable with the illumination of the vitreous base.  Video: Filipe Lucatto MD Salvador 🇧🇷 Edition: Juliana Prazeres MD Filipe Lucatto MD Salvador 🇧🇷