This is a great video to demonstrate a vitrectomy, or FOV, in a patient who has had previous cataract surgery and a posterior vitreous detachment.
Details About the Patient
The patient is about 70 years old and first came to my office for evaluation of chronic floaters in both eyes in 2015. The floaters had been bothering him for at least 2-3 years. A vitrectomy (FOV) was performed to the left eye in 2015 and his post-operative course was uneventful (i.e. went as expected).
Last fall, the patient returned and wanted the floaters removed in his right eye. This is the video of that operation. A 25 gauge vitrectomy was performed, a PVD (posterior vitreous detachment) was already present and no sutures were utilized.
My Comments About This Video
This was performed as an outpatient. He was awake and comfortable. I used the 25 gauge system and did not use sutures.
The music has been graciously permitted by Brooklyn Duo. I like music in the background and I like their music and will hopefully use it more often. Thanks Marnie and Patrick!
Intraocular Lens (IOL)
The first thing to notice about his video is that there is an intraocular implant. At (0:22) in the plane of the iris, you can see the outline of the very clear “plastic” IOL. The intraocular lens is a result of normal cataract surgery. The IOL takes up less space than the natural lens which was replaced by the intraocular lens.
This allows better access to more vitreous, that is, it is easier to remove both anterior vitreous and vitreous off to the sides. There is also no chance of causing a cataract either during the operation or developing a cataract after the operation.
Posterior Vitreous Detachment (PVD)
A PVD is a naturally occurring event, that is, it occurs eventually in everyone. The posterior vitreous is that portion of the vitreous which covers the area including the optic nerve and macula, the posterior portion of the retina.
Though the PVD may be difficult to see, you will notice that the vitrectomy instrument never has to go near the posterior retina as the PVD allows the vitreous to move toward the vitrectomy instrument which remains in the front of the eye.
There is also great concern over floaters in the pre-macular bursa. As you can see, the vitrectomy instruments do not need to approach the area in front of the macula. Any floaters in the vitreous in this location will be removed with the vitreous.
If you have questions or concerns, please ask below!