Advances in Retinal Surgery · Retina Vitreous Surgeons of CNY December 6th, 2014 . Outline o...
Transcript of Advances in Retinal Surgery · Retina Vitreous Surgeons of CNY December 6th, 2014 . Outline o...
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Advances in Retinal Surgery
Jamin Brown, MD Retina Vitreous Surgeons of CNY December 6th, 2014
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Outline o Review 3-Port Vitrectomy o Advances
o Small Gauge Surgery o Valved Cannulas o Vitrectomy cutter design o Fluidics
o Changing management o Future Directions
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3 - Port Vitrectomy
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20-Gauge Opening
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Small Gauge Opening
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Valved Cannulas o!Increases efficiency- no plugs o!Increased self sufficiency o!Optimal IOP control
o!Lower risk of hypotony
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Stable Operative Environment
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Vitrectomy Cutters o!Port position - moved toward tip
o!serve as multifunctional tools o!Forceps, Backflush
o!closer shave o!membrane dissection
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Traditional Scissor based Dissection
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Vitrectomy Cutter Dissection
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Vitrectomy Cutter Dissection
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Improved Fluidics: Cutter Speed o! Vitrectomy cutter = Guillotine cutter o! Increase cut rate decreases retinal motion
o! Stable operating environment o! decreases retinal tears
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Improved Fluidics: Cutter Design o!Conventional
o!Port closed pneumatically, opened via spring
o!Dual Pneumatic drive o!Port is both opened/closed pneumatically o!Allows for control of how much time port open o!Allows for control of flow
Conventional Modern
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Fluidics: Retinal Stability
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Modern Vitrectomy Surgery Ø Advantages
Ø More Efficient Ø Improved fluidics Ø Reduced opening/closing times
Ø Safer Ø Decrease incidence of retinal breaks
Ø Increased patient comfort Ø Faster visual recovery Ø Less corneal topography changes Ø Reduced intraocular inflammation
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Changing Management
o!Retinal Detachments o!Vitrectomy vs. Scleral Buckle vs.
Pneumatic retinopexy o!They all work
o!Lower Initial success with pneumatic o!(65% vs 90+%)
o!Final anatomic success rates 98-100%
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Retinal Detachments
o!Multitude of factors affect choice o!Trend toward more Vitrectomies
o!Improved optics, instrumentation, and light sources
o!Improved safety and efficacy o!Fewer complications than with SB o!Main risk is cataract
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Retinal Detachments Retinal Detachments
Schaal S, Sherman MP, Barr CC, Kaplan HJ. Primary retinal detachment repair: comparison of 1-year outcomes of four surgical techniques. Retina. 2011 Sep;31(8):1500-4.
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RRD Repair using Vitrectomy
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Retinal Detachments o!Scleral Buckle
o!Young Phakic eyes o!No PVD
o!Pneumatic Retinopexy o!Select case
o!Single superior tear
o!Vitrectomy o!Pseudophakic eyes o!PVD
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Future Directions: Smaller Faster o!Decreased cutter size
o!27 Gauge and smaller…
o!Increased cutter speed o!Twin Duty Cycle Cutters
o!16,000 cpm effective rate
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Conclusions
o Advances in Technology o Improved Instruments o Improved Fluidics
o Improves Outcomes o More Efficient o Safer o More comfortable patient
experience
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RRD Repair using Vitrectomy