Here’s a link to a video on how I induce a PVD (Posterior Vitreous Detachment) during FOV (Floater Only Vitrectomy).
During this particular operation, I used:
25 gauge vitrectomy system
Kenalog (used to stain the vitreous)
The operation was performed while the patient was completely awake, yet comfortable. In fact, at the patient’s request, we were listening to Bob Marley during the 10-15 minute operation.
Core Vitrectomy First
The first step is to remove as much of the central, or “core,” vitreous as possible. This is where most of the floaters are usually located, but most importantly, removing the core vitreous first decreases the chance of causing a tear in the retina when I create a PVD.
The vitreous is adherent to the retina in certain places; at the optic nerve, along major blood vessels and to the “anterior” retina near the pars plana.
Regardless of your understanding, the vitreous is a random matrix of protein strands. It’s kind of like a 3D cob web…..pulling on a portion of the vitreous in one area, can cause a tear in another.
Removing the core vitreous, therefore, decreases the chances of inadvertent tears forming….that’s my point.
As you can see in the video, injecting Kenalog or Triesence allows me to stain the otherwise transparent vitreous and allows me to start the process of “inducing” or causing a PVD (posterior vitreous detachment).
This saves time, allows me to “see” what I’m doing and, therefore, further reduces the chances of causing complications such as a retinal tear.
Inducing a PVD
This is the tricky part. I basically start tugging on the vitreous to pull it away from the retina. The video captures this nicely.
Using the same instruments I use for the vitrectomy, I start “sucking” on the vitreous. Eventually I’m able to create a small separation between vitreous and the retina. I enlarge this area until the whole “posterior” vitreous becomes separated from the retina!
Completing the Vitrectomy
Finishing the vitrectomy now becomes a snap. With most of the vitreous no longer attached to the retina, I can now remove the vitreous in the most efficient and effective way, thereby (in theory) reducing the chance of “frill.”
I maintain that vitrectomy surgery is very, very safe. When compared to cataract surgery, vitrectomy with/without inducing a PVD is comparable to cataract surgery when you consider the greatest possible complications: infection and retinal detachment.
All the best!
Randall V. Wong, M.D.
Fairfax, Virginia 22030