Dear Editor,
I read with keen interest the innovation of vacuum-assisted cortex removal by Nachiappan et al.[1]
I believe a tradition is kept alive only by something being added to it. The authors have added a device of active vacuum cortex removal to our armamentarium using a coiled steel spring on the plunger of the syringe (avoiding dynamic suction by pulling the plunger and instability).
This is an excellent technique for vitreous tap and biopsy in cases of endophthalmitis, uveitis, and masquerade syndromes (ocular lymphomas). A 10 mL syringe with a coiled spring is connected to the aspiration port of the vitreous cutter and the other port to the vitrectomy machine console. The vitrector is introduced into the mid vitreous through the pars plana and activated (at a low cut rate of 600 cuts) to aspirate an undiluted sample specimen of vitreous into the syringe with the spring in the state of compression. The potential energy is converted to kinetic energy by slowly releasing the pressure on the flange with the thumb. This leads the spring to recoil slowly and generates a controlled suction that aspirates the cut vitreous sample into the syringe.
The advantages are-
Surgeon can concentrate on the procedure without the distraction of aspirating the plunger
Constant visualization of the opaque and the pathologic vitreous into the port
Ease of large volume aspiration by just passively controlling the plunger rebound
Sudden collapse of the eyeball can be avoided and infusion is started immediately.
Hence, this modification makes the process of vitreous biopsy safe and sound.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
Reference
- 1.Nachiappan S, Vedachalam R, Sulaiman SM, Venkatesh R, Odayappan A. Vacuum assisted cortex removal-A novel change to tradition. Indian J Ophthalmol. 2022;70:4082–5. doi: 10.4103/ijo.IJO_1548_22. [DOI] [PMC free article] [PubMed] [Google Scholar]