Trimanual technique using assistant-controlled light probe illumination and wide-angle viewing system in 23-gauge sutureless vitrectomy for diabetic tractional retinal detachment.

BACKGROUND AND

OBJECTIVE

The authors propose a novel trimanual vitreous surgery using assistant-adjusted endoillumination during 23-gauge sutureless vitrectomy for severe diabetic tractional retinal detachment (TRD) under noncontact wide-angle viewing system.

MATERIALS AND

METHODS

The trimanual sutureless vitrectomy under a wide-angle viewing system consisted of (1) a fourth-port microcannula in the inferior 6-o'clock position; (2) dynamic and specular illumination by an assistant-controlled light probe inserted through the fourth port; and (3) membrane dissection and bleeding control using two intraocular instruments.

RESULTS

Six eyes of four patients who underwent trimanual diabetic vitrectomy were evaluated. Recurrent TRD was detected in one eye, and a second operation was performed. There were no intraoperative sclerotomy-related complications or postoperative hypotony, increased IOP, or endophthalmitis. Final anatomic and functional success was achieved in all six eyes.

CONCLUSION

The trimanual technique is valuable for membrane dissection in severe diabetic TRD. The optimal and dynamic illumination provided a high-quality stereoscopic view under a wide-angle viewing system. Careful coordination between a surgeon and an assistant facilitates this technique.