NEW TOOL & TECHNIQUES
FOR VR SX

Steve Charles (Memphis)

Epiretinal membrane dissection and removal, drainage of subretinal fluid, hemostasis and retinopexy are the most crucial and difficult tasks in vitreoretinal surgery. Using optimal instruments, combined function tools, and fewer devices leads to safer, faster, more efficient surgery.

Peeling is best utilized for low adherence epiretinal membranes and ILM such as are seen in epimacular membranes, macular holes and PVR. The author never uses pics, MVR blades, visco-dissection, or forceps techniques that require one blade between the ERM/ILM and the retina. The author recommends the new Grieshaber end-grasping forceps for EMM and macular hole cases and using the diamond coated forceps for PVR. Scissors delamination using the new Grieshaber curved scissors are used for diabetic traction detachments. These scissors are appropriate for access segmentation as a first step in delamination as well. Both forceps peeling and delamination are usually used in an inside-out direction to reduce retinal breaks. Neither ICG nor PFC are needed with these techniques.

The InnoVit cutter at 180 cuts/minute limits flow preventing a surge of fluid through the port after sudden elastic deformation of dense epiretinal membrane. Flow limiting via use of high cutting rates enable safe use of higher vacuums and removal of diabetic epiretinal membranes with less risk of iatrogenic retinal breaks. The Alcon EndoZapper is used as the "second" instrument in all diabetic vitrectomy cases. This device, originally reported as the tissue manipulator by Brooks McEuen, is now available in twenty-gauge with excellent illumination. Obvious vascular attachment points can be pre-coagulated and the Accurus VGFI system with foot-controlled "tamponade" can be used to control post-cutting bleeding until the EndoZapper can be coagulate the site.

The Chang end-aspirating laser probe from Alcon was developed for simultaneous aspiration of subretinal fluid and laser retinopexy. Used in conjunction with posterior drainage retinotomy, this is an ideal tool. The author has found that it also ideal for achieving hemostasis and performing PRP during diabetic vitrectomy.


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