Vitrectomy in aphakia: a simplified technique for fundus visualisation.

Abstract

SUMMARY By using a small air bubble that fills about two thirds of the anterior chamber the erect image of the fundus of the aphakic human eye can be visualised clearly during vitrectomy, enabling the surgeon to operate without the need for vitrectomy lenses. The refractive power of the human aphakic eye is calculated here and the image site and size are presented.During vitreous surgery surgeons use different types of vitrectomy lenses that are either fixed to the corneosclera or held by an assistant to provide a clear view of the fundus. In patients undergoing vitrectomy the removal of the crystalline lens is rather common. In this paper we revive a simple old optical principle that we hope will simplify and shorten the vitrectomy techniques in aphakia.In our aphakic patients undergoing vitrectomy and in patients undergoing pars plana lensectomy and vitrectomy we were able to provide a clear view of the fundus during surgery simply by injecting through a limbal incision a small air bubble that fills one-half to two-thirds of the anterior chamber. Owing to the bubble's small size and to the minimal movement of the eye during surgery the back of the cornea was kept wet all the time, leading to perfect visibility during the whole procedure. This obviates the fogging effect caused by irregular wetting of the back of the cornea when the whole eye is filled with gas or air. Peripheral portions of the fundus were easily visualised by tilting the globe in the desired direction, the examination being aided by the superior position of the air bubble in the anterior chamber. The change in magnification owing to the relative peripheral corneal flattening is gradual and practically negligible.

Intraoperative fundus inspection during surgery

“…5 Air in the anterior chamber is used to help seal surgical wounds and has been shown to prevent inflow of ocular surface fluid into the eye. 6 Fundus visualization during vitrectomy only in aphakia using the air bubble technique had been earlier described as an alternative to vitrectomy lenses, 7,8 and it was reported to be safe and cost-effective. 8 However, visualization of the retina using an air bubble is limited and not even close to the quality of direct or indirect ophthalmoscopy using artificial lens systems.…”

Air Bubble Technique for Fundus Visualization during Vitrectomy in Aphakia

“…In 1989, Asfour and Nassar described a simplified technique for fundus visualization during vitrectomy in aphakia. They provided a clear view of the fundus during surgery simply by injecting a small air bubble that fills one-half to two-thirds of the anterior chamber [ 6 ].…”