Optimal Visualization, Optimal Instruments and Optimal Technique

Abstract

The A and O of a successful vitreoretinal surgery are optimal visualization, optimal instruments and optimal technique. This is different to phacoemulsification surgery. Visualization is also very important in cataract surgery as well as a good phaco machine, but instruments and the technique are of minor importance. Regarding instruments, even for an experienced surgeon, there is a significant difference when using different peeling forceps. Test all available forceps and find the one which is most suitable for you. The vast pathological spectrum from PVR detachment to dislocated IOL requires different instruments, the optimal instrument for the specific indication. The same applies to technique. Every pathology requires an optimal technique. You can operate a dark-brown nucleus with phacoemulsification. But the likelihood that you will encounter a posterior capsular rupture, zonular lysis or decompensated cornea is high. This is not the case, if you use the SICS (modified ECCE) technique. If you operate a difficult PDR with tractional membranes with monomanual vitrectomy, you will likely run into problems such as retinal tears or incomplete removal of the membranes. Insert a chandelier light and things are easy. If you operate an ora dialysis with vitrectomy instead of episcleral buckling, then you made a risky choice because the success rate with buckling surgery is 100 %.