General Considerations and Techniques |
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of Pars Plana Vitrectomy |
3.1General Considerations
As any surgical procedure, pars plana vitrectomy is learned in four steps: observation; performing sections of the procedure and then the entire surgery under supervision; performing the surgery without supervision but with an experienced surgeon as a backup close by; performing the surgeries on your own. There is no shortcut to this process. However, with regards to pars plana vitrectomy, valuable knowledge and skills can be gained before starting to perform the surgery.
Pits & Pearls
Assist experienced surgeons as much as you can before you begin to perform vitrectomy. You will automatically acquire the basic ‘do’s and don’ts’ during these procedures. Get scrubbed to assist; this is the only way to get really involved, and you will learn a lot more than by just looking at a TV screen or the surgeon´s shoulder.
Pits & Pearls
Examine all vitrectomy patients the day before the surgery. Overnight plan how you intend to operate on each patient (anaesthesia, surgical procedure, instruments, dye and tamponade). As a rule of thumb, assist in every type of surgery from silicone oil removal to retinal detachment ten times. Then you will have acquired specific knowledge on how a particular pathology is managed.
U. Spandau, H. Heimann, Practical Handbook for Small-Gauge Vitrectomy, |
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DOI 10.1007/978-3-642-23294-7_3, © Springer-Verlag Berlin Heidelberg 2012 |
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3 General Considerations and Techniques of Pars Plana Vitrectomy |
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Pits & Pearls
‘You see only what you look for, you recognize only what you know’. Acquire a broad knowledge of medical retina and develop your skills with binocular indirect ophthalmoscopy. If you master indirect ophthalmoscopy, you will be able to see things others will miss, in particular when there is a poor view of the fundus (for example, vitreous haemorrhage with some areas of the peripheral retina still visible or a gas-filled eye). With a sound knowledge of medical retina, you will be able to establish the correct diagnosis before and during the surgery in certain cases. These skills will help you to plan your strategy for surgery, deal with unexpected findings during the surgery (for example, unusual retinal changes after removing a vitreous haemorrhage) and finally, avoid unnecessary interventions.
Pits & Pearls
If possible, try to learn and master cataract surgery before learning pars plana vitrectomy. This will not only teach you the ABC of ophthalmic surgery under an operating microscope but will also be very useful in cases of combined surgeries or anterior segment problems during the vitrectomy (for example, silicone oil prolapse, dislocated IOL or lens touch).
Pits & Pearls
Acquire a good knowledge of ultrasound echography and perform this examination yourself before your surgeries. This will enable you to construct a 3D image of the situation in front of you in cases of vitreous haemorrhage or poor view, help you to avoid unnecessary surgeries and help you in developing the correct strategy for the surgery.
Pits & Pearls
Learn and practise scleral buckling surgery. This technique is still unsurpassed in localized retinal detachments, in particular in young and phakic patients with an attached vitreous. If you do not practise it, you will be unable to give the appropriate treatment to a child with a traumatic retinal detachment and an ora dialysis, for example.