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UPDATE 13 by Ellen Stodola EyeWorld Senior Staff Writer Anterior vitrectomy tips from the ASCRS Retina Clinical Committee less trauma to the cornea and iris, as well as more complete vitreous re- moval. While a pars plana approach is appropriate, this doesn't mean anterior surgeons should remove floaters, etc., Dr. Charles added. It is appropriate for them in the case of capsular rupture in cataract surgery to do a vitrectomy through the pars plana. Dr. Charles recommended not going through the cataract wound. He said to suture and then insert the cutter through a sideport if the sur- geon is not comfortable with a pars plana approach. Infusion should always be through a sideport. Chair of the ASCRS Retina Clinical Committee offers tips for anterior segment surgeons who find the need for this technique in cataract surgery A nterior segment surgeons must make some difficult decisions when they need to perform an anterior vitrectomy, and there is some disagreement on the best approach to take. To help ASCRS members, the ASCRS Retina Clinical Committee has been working on an initiative to further educate anterior segment surgeons regarding anterior vitrectomy. As part of this effort, Steve Charles, MD, Memphis, Tennessee, chair of the ASCRS Retina Clinical Committee, offered tips for anterior segment surgeons handling anterior vitrectomy and explained issues they may encounter. Never use cellulose sponges, not even to test for vitreous, Dr. Charles said. Vitreous cutters are a better option, as sponges cause marked intraoperative vitreoretinal traction. Initially, techniques used cellulose sponges, however, it was later dis- covered that lifting the sponge could cause this traction. Dr. Charles said vitreous cutters are safer and should be used with the highest possible cutting rates in order to minimize pulsatile vitreoretinal traction. Triamcinolone is helpful, Dr. Charles said, advocating for Tries- ence (Alcon, Fort Worth, Texas). This option is preservative-free, and triamcinolone can help with better visualization in anterior vitrectomy. What is controversial is that many surgeons are still uncomfort- able going through the pars plana and prefer a translimbal approach, Dr. Charles said. Pars plana ante- rior vitrectomy is appropriate for anterior segment surgeons. There is Dr. Charles stressed the impor- tance of not using a trocar-cannula approach. Instead, he advocates using an MVR blade approach. The trocar-cannula has significantly higher insertion force and great chance of wound disruption. This is not a good approach, especially since the eye is often soft in these scenarios. Dr. Charles also said a scleral tunnel made with a trocar-cannula is a bad idea for anterior vitrectomy. If you have a soft eye and try to make an angulated incision—to construct a scleral tunnel—suprachoroidal insertion of the cutter may result. Stay tuned for more tips and insights about anterior vitrectomy from the ASCRS Retina Clinical Committee. EW Editors' note: Dr. Charles has financial interests with Alcon. Contact information Charles: scharles@att.net Ruptured capsule at cataract surgery Source: Byron Wood, Vitreous Microsurgery, Fifth Edition Read more from Dr. Charles on this topic in "Management of capsule rupture at cataract surgery" on page 68 of the October 2016 issue of EyeWorld.

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