In addition to indications describe in other chapters, vitrectomy is occasionally performed for the following:
Pars plana vitrectomy with or without lensectomy 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.
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.
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.
All rights reserved. No part of this publication which includes all images and diagrams may be reproduced, distributed, or transmitted in any form or by any means, including photocopying, recording, or other electronic or mechanical methods, without the prior written permission of the authors, except in the case of brief quotations embodied in critical reviews and certain other noncommercial uses permitted by copyright law.