A novel, low-cost and practical illumination approach for bimanual vitrectomy

Abstract

Cite this article as: Aykut V, Esen F, Oguz H. A novel, low-cost and practical illumination approach for bimanual vitrectomy. North Clin Istanb 2020;7(3):275-279. P roper illumination of the surgical site is a must in vitreoretinal surgery. Therefore, the development of the first endoillumination probe revolutionized vitreoretinal surgery around forty years ago [1]. Since then, many developments have been achieved in both vitreoretinal surgery illumination systems and instruments.Subsequently, the surgical outcome has become better and better over time [2].Patients with proliferative vitreoretinopathy (PVR) are especially challenging cases and it is very hard to manage these cases with standard approaches. The development of chandelier light systems allowed biman-ABSTRACT OBJECTIVE: The present study aims to describe a novel, low-cost, transconjunctival sutureless bimanual vitrectomy illumination approach and evaluate its surgical outcome. METHODS:Thirty-six eyes of 36 patients who underwent pars plana vitrectomy with the above-mentioned technique were included in this study. Four trocars were placed in superotemporal, inferotemporal, inferonasal and superonasal quadrants. A piece (23 mm) was cut from 30G intravenous cannula and a 30 mm endoillumination probe was placed inside this sleeve. This design limited the entry of the light probe into the vitreous cavity to 7 mm and provided a safe illumination by the assistant without the risk of damaging the retinal tissue. RESULTS:Thirty-six eyes of 36 patients were included (24 male, 12 female, mean age: 58.4±14.3 years) in this study. Thirty patients had rhegmatogenous retinal detachment (six of these patients with coexisting choroidal detachment), four patients had diabetic tractional retinal detachment, one patient had a nucleus drop and one patient had an intraocular foreign body. The mean follow-up time after pars plana vitrectomy (PPV) was 5.05±4.4 months. LogMAR best-corrected visual acuity improved significantly after PPV (p<0.001). Postoperative complications included recurrent detachment in two eyes, hypotony in one eye and endophthalmitis in one eye. The transient rise in intraocular pressure was observed in 19 patients, but there was no significant difference between the preoperative and postoperative mean IOP in the long term follow-up.CONCLUSION: This bimanual vitrectomy system provided favorable outcomes without increasing the cost of standard PPV. The advantage of this system over the chandelier illumination include the reduction in glare, the possibility to change the direction of the light during the surgery to better illuminate the surgical site and the lower cost. This approach can be used in any vitrectomy system (20G, 23G, 25G, and 27G) by changing the size of the IV cannula.