Dear Sir,
I read with keen interest the article on the surgical technique of limited vitrectomy in phacomorphic glaucoma by Sachdev et al.[1] in the December 2017 issue of Indian Journal of Ophthalmology.
I have been employing the procedure of pars plana toilet vitrectomy performed 4-mm posterior to the limbus in various clinical situations with shallow anterior chamber to create adequate space and to facilitate better surgical maneuvering.
The cases in which this surgical technique is used include (1) narrow-angle glaucoma with cataract for combined surgery or cataract surgery or trabeculectomy, (2) posttrabeculectomy with shallow anterior chamber with peripheral anterior synechiae (PAS), (3) malignant glaucoma; (4) cataract surgery with PAS with vitreous loss, (5) nanophthalmos with cataract; (6) relative anterior microophthalmos, (7) Urrets-Zavalia syndrome with PAS, (8) lens-induced Glaucoma, (9) iris bombe, (10) postsilicone oil shallow angle, and (11) pediatric cataract surgery for pars plana posterior capsulectomy and anterior vitrectomy.
I use pars plana 23G vitrectomy along with an anterior chamber maintainer to help in spontaneous reformation and deepening of the anterior chamber. In some cases, incremental anterior chamber deepening is done using viscoelastic injection from the side port after the eye is softened in a controlled manner using pars plana vitrectomy.
The cases with PAS with vitreous in the anterior chamber or uveitis, a manual separation of the PAS are performed using an iris repositor. The amount of vitrectomy depends on the level of the anterior chamber depth needed to perform a safe cataract surgery. The technique can also be performed with a 20-gauge vitrector. This procedure, which I call “toilet vitrectomy” is safe and easy if we maintain the tip of the vitrector in the pupillary axis under constant visualization and do a mid- and anterior vitrectomy.
I agree with the authors that this technique of limited pars plana vitrectomy is useful in situ ations with shallow anterior chamber.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
Reference
- 1.Sachdev R, Gupta A, Narula R, Deshmukh R. Limited vitrectomy in phacomorphic glaucoma. Indian J Ophthalmol. 2017;65:1422–4. doi: 10.4103/ijo.IJO_668_17. [DOI] [PMC free article] [PubMed] [Google Scholar]