Chapter 31

Other Vitrectomy Indications

In addition to indications describe in other chapters, vitrectomy is occasionally performed for the following:

1. Complicated Retinal Capillary Haemangioma (von Hippel-Lindau Syndrome)

Rarely, pars plana vitrectomy may be required for retinal capillary haemangioma complicated by vitreous haemorrhage or retinal detachment.[1]

Singh AD et al. Treatment of Retinal Capillary Hemangioma. Ophthalmology 2002;109:1799-1806.

2. Aqueous Misdirection (Malignant Glaucoma)

Pars plana vitrectomy with or without lensectomy[2] may be required to manage aqueous misdirection with elevated intraocular pressure that is refractory to more conservative therapy (such as mydriatic-cycloplegics and laser anterior hyaloidotomy and posterior capsulotomy). Concurrently, multiple peripheral iridotomies can be made with the cutter. The surgeon may also consider a zonulectomy whereby a passage-way is made from the pars plana through the zonules and into the sulcus to insure that an anterior hyaloidotomy has been performed.

3. Cyclodialysis Cleft

A cyclodialysis cleft occurs when there is disinsertion of the meridonal ciliary muscle fibers from the scleral spur. This is usually secondary to trauma. Many techniques for repair have been described, including use of cryopexy, diathermy, diode and argon laser coagulation, sutures, scleral buckling and vitrectomy with gas endotamponade.[3]

Ioannidis AS et al. Cyclodialysis Cleft: Causes and Repair. Curr Opin Ophthalmol. 2010;12(2):150-4.

4. Sub-internal Limiting Membrane (ILM) Hemorrhage

A sub-ILM hemorrhage may occur with a macroaneurym, valsalva or Terson’s syndrome. Small haemorrhages can be managed conservatively, but large hemorrhages be considered for vitrectomy, especially if there is break through vitreous hemorrhage.

A vitrectomy is performed and a pick (e.g. 25-gauge needle on a 1ml/cc syringe) and/or micro-forceps can be used to peel the ILM before aspirating the hemorrhage.

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