Vitreous Tap When AC Shallow During Phaco

May 6, 2009

I think this maneuver is under-utilized. When I am faced with a shallow anterior chamber with significant positive pressure, and I am having some trouble just getting my instruments in the eye, then I bite the bullet. Instead of trying to inject more and more viscoelastic,  I take down conjunctiva, enter the pars plana at 3.5mm from the limbus, and either the liquified vitreous pours out, or I do a very quick (1 minute) vitrectomy. Immediately, the AC is deep and the eye is soft (don’t take out too much vit, or the eye will be too soft), and the phaco becomes an absolutely routine case. I don’t have to worry about my rhexis running away, or my posterior capsule coming up at me. I have done this only three times, and each time it saved the day. I know that Dr. Fine in Oregon is a big advocate of this. Close the sclera with a 7-o vicryl, and just look at the fundus the next day to make sure nothing funny happened.

This maneuver is very easy, and even low-volume guys like me can do it. Trust me- you’ll be grateful.

 

 



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2 Responses to “Vitreous Tap When AC Shallow During Phaco”

  • ari

    the vit tap maneuver is for cases when the ac is shallow from the very begining in eyes where one would expect it from the pre-op exam- a large cataract crowding the ac, short eye, narrow angles etc. sudden shallowing during surgery is a different animal, and of course one would have to rule out expulsive hemorrhage before doing a vit tap. doing a vit tap in an expulsive will, of course, not help- the intraocular contents will try to leave the eye until the hemorrhage is stopped. the vitrector may also harm the retina as it bulges forward.

  • Grace Wu

    Thank you for the useful tip.

    I would like to find out from what re these cases of shallow anterior chambers ? Could this be used as a planned phaco/ combined with ant vitrectomy in eyes known to have very shallow AC?
    What if the unexplained sudden shallowing AC is due to expulsive hemorrhage and the surgeon has not realised that yet, and anterior vitrectomy was carried out, what will happen ?

    Thank you

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