|Year : 1983 | Volume
| Issue : 7 | Page : 1057-1059
Parsplana, open sky and anterior vitrectomy
TP Ittyerah, Sajan George
Vtreo Retional & Ophthalmic Plastic Surgery unit, CBM Ophthalmic Institute, Little Flower Hospital, Angamally, Kerala, India
T P Ittyerah
Vitreo Retinal & Ophthalmic Plastic Surgery Unit, CBM Ophthalmic Institute, Little Flower Hospital, Angamally, Kerala
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Ittyerah T P, George S. Parsplana, open sky and anterior vitrectomy. Indian J Ophthalmol 1983;31, Suppl S1:1057-9
Vitrectomy is a recently popularised surgical technique in Ophthalmology. Even though vitreous surgery was attempted in the 19th Century itself, the instrumentation for perfect vitreous surgery was introduced recently. The instrument used in this series is Peyman Vitrophage. This is the only disposable vitrectomy instrument available and cost is also well with in the reach of an average Indian Ophthalmologist. Hence it is currently popular in India as evidenced by recent publication in India by various authors.,,.
| Material and methods|| |
Vitrectomy was performed in 20 eyes of 20 patients. Parsplana vitrectomy was done in 8 eyes, mainly for non absorbing haemorrhages and endophthalmitis.
Open sky vitrectomy was done in 3 eyes. 2 for perforating injuries while repairing it and one while doing combined keratoplasty with cataract extraction.
Anterior Vitrectomy was done in 9 eyes mainly for vitreous loss during Cataract surgery.
Peymans vitrophage with Vijaya Sukut console was used in all the cases. The vitrophage was reused 4 to 5 times after gas sterilization with ethyleneoxide, even though it was ment for use only once.
Selection of Patients
Parsplana Vitrectomy was done in endophthalmitis and non absorbing vitreous haemorrhage of more than 6 months duration. All of them had pre-operative vision HM or less than HM. These were patients in whom nothing else is likely to improve the vision. The decision for open sky and anterior vitrectomy was taken on the operation table while proceeding with surgery.
Check Machine first
Indirect Ophthalmoscopic control for Parsplana Vitrectomy
Operating spectacle for anterior vitrectomy
Operating microscope for open sky vitrectomy
Parsplana vitrectomy was done under indirect ophthalmoscopic control. Patients were operated under local anestheasia with Xylocaine 2% and Marcaine 0.5%. The four recti were fixed and the bulbar conjuctiva incised perpendicular to the limbus in the quadrent opposite to the lesion suspected. The 3mm sclerotomy was made 4mm away from limbus and parallel to the limbus. A preplaced 5 zero mersilen mattress suture put at the selerotomy.
The machine was checked to find out whether it was properly working. I used 5% dextrose with Gentamycine (.05 cc added to 500 cc.) for infusion instead of B.S.S. (Balanced Salt Solution).
A cut was made in the parsplana with Graefes knife after cauterisation with MIRA high frequency diathermy and the vitrophage introduced. The preplaced suture tightened. When the end of the vitrophage was visualised cutting was started. The cutting was controlled by a foot switch, suction by the fingertip by closing the opening of vitrophage and infusion by the switch in the machine.
Once the vitreous was cleared the machine was swithched off and the eye ball was allowed to build up the normal tension and infusion stopped before the instrument was gently removed. The assistant tightened the mattress suture and the conjuctiva sutured over it.
Parsplana Vitrectomy Procedure
Fix 4 Recti,
Incision 4mm away from Limbus 3mm long on the sclera at parsplana. Matress sutures with 5 zero mersilen passed.
Introduce the cutter and tight the suture.
Start cutting only after seeing the tip.
It open sky vitrectomy Zeiss operating microscope was used. The instrument was passed through the cornea either through the opening made for corneal gragting or through the perforating injury wound.
In anterior vitrectomy the instrument was passed through the limbal incision and vitrectomy was done to clear of vitreous from the anterior chamber.
| Observation|| |
The technique was found to be very effective in other-wise hopless cases. It was found to he useful in managing successfully and easily the vitreous loss in cataract extraction. It is a good additional instrument while tackling perforative injuries of the globe.
| Discussion|| |
Peymans vitrophage in combination with Vijaya Sukut is a fairly satisfactory instrument for vitrectomy. Since we were re-using she vitrophage, we were keeping two seperate sets-one for septic cases like endophthalmitis and another for clean cases like vitreous haemorrha e There was no infection in any of the clean cases operated with gas sterilised vitrophage.
It is a good instrument combination to be kept ready in all cases of cataract extractio so that one can use it if vitreous loss occurs during cataract surgery. Anterior vitrectomy can be performed by any cataract surgeon without difficulty but to do closed parsplana vitrectomy one should be thorough with the indirect ophthalmoscopy. It is exclusively the field of a retinovitreal surgeon. Even.in this preliminary report itself I got good results and I am sure that the prognosis is likely to improve further in the future series.
| Summary|| |
Parsplana, Open sky and anterior vitrectomy (through the limbus) were done in 20 cases. The parsplana vitrectomy was done under indirect ophthalmoscopic control mainly for vitreous haemorrhage and endophthalmitis. Open sky vitrectomy was done for perforating injuries under operating spectacle (4 X magnification) and anterior vitrec tomy was done for vitreous loss during Cataract extraction. The surgery was performed with Peyman's Vitrophage attached to Vijaya Sukut. The patients were followed up for a period of one year and fluorescein angiography was doen in some of the cases of vitreous haemorrhages to study the haemodynamics.
The vision improved and media was cleared in most of the cases and the technique was found to be quite useful in several occasions. Chewing of iris and retina were few of the complications noted.
| References|| |
Chandran Abraham & S.S. Badrinath 1981 Ind J. of Ophthalmol 19:359.
Nagpal P.N.,1981, Ind. J. Ophthalmol. 19:431.
Nampermalsamy, 1976, Vitrectomy Personal experience. ACTA 6th Afro Asian Congress of Ophthalmology - Madras P. 181.
[Table - 1], [Table - 2], [Table - 3], [Table - 4], [Table - 5], [Table - 6]