OPHTHALMOLOGY SURGEONS EXTEND THEIR AMBIDEXTRICITY :VITREOUS LOSS : BIMANUAL BIEDAL TECHNIQUE .

21 Apr, 2022

Vitreous loss is defined as anterior displacement or prolapse of the vitreous gel beyond the plane of the posterior lens capsule. During cataract surgery, it can be a difficult complication to mitigate and may cause adverse outcomes in visual acuity. Performing phacoemulsification with vitreous loss is complex because of the disruption of the posterior lens capsule, which usually functions as an anatomical barrier, separating the vitreous gel from the forces involved in lens fragmentation and aspiration. Posterior capsule disruption causes vitreous prolapse that could dislocate lens fragments into the posterior segment, resulting in vitreous traction and retinal tear.
A  new surgical technique for potentially a safer and efficient phacoemulsification with predicted vitreous loss using phacoemulsifier and pars plana vitrector bimanually and bipedally (Bimanual-bipedal technique). 
this calls for a lox of dextricity and ambidextricity. With lot of ophthalmologists use most manuevers with both hands  ,manupulating two probes in two hands ,is like simultaneously performing two surgeries at one time.

First, conventional phacoemulsification was attempted with the PPV infusion port closed. When the vitreous prolapsed as predicted, the vitrectomy cutter was inserted through the left-hand port, and the PPV infusion port was opened.

The left foot was moved from phacoemulsifier footswitch to vitrector footswitch. While dissecting vitreous by vitrector, lens fragments were retained by aspiration of phacoemulsifier tip to prevent movement. After vitrectomy, the right foot was moved from microscope footswitch to phacoemulsifier footswitch. The lens fragment is retained in place through aspiration of vitrectomy cutter (cutting rate zero), which prevents the complication of displaced lens fragment retrieval within the vitreous cavity. This enabled phacoemulsification to proceed at the level of lens capsule depth.

WHAT WAS KNOWN

• Vitreous loss during cataract surgery is predictable in patients who have phacodonesis, lens luxation/subluxation, and other pathologies including pseudoexfoliation, postangle-closure glaucoma attack, congenital zonular compromise, and a history of trauma to capsular bag or zonular fibers.
• Once the vitreous loss is identified, phacoemulsification should be ceased and the probe carefully withdrawn from the eye to minimize traction on the vitreous.

WHAT THIS PAPER ADDS

• Vitrectomy cutter can be used either as vitreous cutter (high cutting rate) or lens–cortex aspirator (zero cutting rate). Phacoemulsification bimanual technique was performed with vitrectomy cutter as retainer (zero cutting rate).
• Lens fragments were synergistically retained with aspiration by vitrectomy cutter and phacoemulsification probe to prevent displacement.
• Bimanual-bipedal technique may allow safer and more effective treatment for patients by cataract surgeons who have the vitreoretinal surgical skill and experience to deal with vitreous loss during cataract surgery.

Great technique ps read Article by Ninomiya, Yoshihiko MD et.al 

Phacoemulsification with vitreous loss using phacoemulsifier and vitrector concurrently: bimanual-bipedal technique

Ninomiya, Yoshihiko MD; Fuchihata, Mutsumi MD; Ninomiya, Sayuri MD

Author Information

Journal of Cataract & Refractive Surgery: April 2022 - Volume 48 - Issue 4 - p 504-507

doi: 10.1097/j.jcrs.0000000000000884

Publisher: Dr.Venkat | rangalakshmii netralaya