Pars Plana Vitrectomy, Pars Plana Lensectomy and Sulcus IOL Insertion

In this surgical video, Drs. Michael Cohen and Chirag Shah perform a pars plana vitrectomy, pars plana lensectomy and sulcus IOL placement in a 63-year-old female after posterior capsule rupture during phacoemulsification. This case highlights the importance of inducing a complete posterior vitreous detachment (PVD) prior to inserting the fragmatome into the vitreous cavity. This step is important as it limits the amount of vitreous traction created by mechanical manipulation of the large fragmatome, possibly minimizing the subsequent development of retinal tears and/or detachment.

They begin with a local peritomy and horizontal wound creation in anticipation of needing to enlarge the wound to remove the nucleus. Next, an anterior vitrectomy is performed along with careful removal of the cortical material. This material very gently stripped away to maintain the anterior capsule for sulcus IOL placement at the end of the case. A core vitrectomy follows, and triamcinalone is instilled into the vitreous cavity to highlight to posterior hyaloid and aid in visualization. The nucleus is gently moved aside to allow sufficient space for PVD induction. Thorough vitrectomy is completed, allowing the fluidics of the vitrectomy machine to assist in PVD creation. Scleral depression is used to shave the vitreous base. Laser is applied to areas of hemorrhage that could be consistent with small retinal tears. The superotemporal sclerotomy is enlarged and the fragmatome is inserted into the vitreous cavity to remove the remaining lens material. Once again, the periphery is inspected for 360 degrees with scleral depression to make sure there are no tears or detachments. Careful anterior washout is performed, and the anterior chamber is then reformed with viscoelastic. An IOL is inserted into the sulcus and carefully dialed into position. This patient had an excellent refractive result postoperatively.

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