Management of vitreous loss during cataract surgery under topical anesthesia with transconjunctival vitrectomy system.
OBJECTIVE
A new technique to manage posterior capsular rupture with vitreous prolapse into the anterior chamber during phacoemulsification under topical anesthesia using the sutureless self-sealing 25-gauge transconjuctival vitrectomy system.


METHODS
In the event of vitreous prolapse into the anterior chamber, the corneal wound is sutured and cleared of vitreous. A trans conjunctival 25-gauge sclerotomy through the pars plana is made. The high speed 25-guage trans-conjunctival vitrectomy system (TVS-25) under topical anesthesia is introduced and vitrectomy is performed to clear the anterior chamber of vitreous. An anterior vitrectomy is also done. A foldable intraocular lens is subsequently inserted.


RESULTS
The vitrectomy is performed in a closed chamber maintaining normal intraocular pressure. The high-speed cutter exerts minimal traction on the vitreous. The accessibility to vitreous improves through the pars plana route ensuring more complete removal of the vitreous and restoration of normal anatomy. Topical anesthesia avoids the risks of globe perforation, retrobulbar hemorrhage, and prolonged postoperative akinesia of the eye.


CONCLUSIONS
The 25-gauge pars plana incision is small and self-sealing. This makes the procedure fast, effective, painless and safe.
Shah
V A
VA
Department of Ophthalmology, University of Florida College of Medicine, Jacksonville, USA.
Gupta
S K
SK
Chalam
K V
KV
D000772:Anesthesia, Local; D002387:Cataract Extraction / Q000009:adverse effects*; D003228:Conjunctiva / Q000601:surgery; D004867:Equipment Design; D005128:Eye Diseases / Q000209:etiology / Q000601:surgery*; D006801:Humans; D007431:Intraoperative Complications; D007903:Lens Capsule, Crystalline / Q000293:injuries; D007910:Lenses, Intraocular; D018918:Phacoemulsification / Q000009:adverse effects*; D012421:Rupture / Q000150:complications / Q000601:surgery; D014821:Vitrectomy / Q000009:adverse effects* / Q000295:instrumentation / Q000379:methods; D014822:Vitreous Body