VITREOUS SURGERY

Vitreous surgery is useful for a broad spectrum of intraocular disorders. Airtight and watertight incisions measuring 1-4 mm are made in the pars plana and sclera (  Figure 9-19). One incision is used for an indwelling gravity-fed infusion terminal, which maintains the desired tension and configuration of the globe. Surgical gases and medications are also instilled through this terminal. Another incision is used for a hand-held endoilluminator, which illuminates the contents and all of the walls of the vitreous cavity. The illuminated structures are viewed microscopically through the pupil with the aid of a corneal contact or other lens that neutralizes the light-focusing power of the eye. The remaining incision is used to allow for instrumentation (severing or removal of tissue), diathermy, and laser photocoagulation (  Figure 9-19).

Vitreous surgery provides access to virtually all of the intraocular tissues between the endothelium of the cornea and the retinal pigment epithelium. Surgery is most commonly done (1) to remove vitreous opacified by blood (  Figure 9-20 top), (2) to remove shrunken vitreous causing traction retinal detachment (  Figure 9-20 middle), (3) to treat vitreous contracture complicating retinal detachment (  Figure 9-20 bottom) (see preretinal membranes), (4) to remove metaplastic membranes that deform or detach the sensory retina (  Figures 9-18 and   9-19), (5) to create an optical opening in recalcitrant pupillary membranes, and (6) to remove infected vitreous in endophthalmitis (so as to dilute the organismal toxins and reduce the population of causal organisms and to instill therapeutic solutions). Vitreous surgery is frequently combined with scleral buckling for retinal detachment.

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