Trimanual Technique Using Assistant-Controlled Light Probe Illumination and Wide-Angle Viewing System in 23-Gauge Sutureless Vitrectomy for Diabetic Tractional Retinal Detachment

Abstract

BACKGROUND AND OBJECTIVE: The authors propose a novel trimanual vitreous surgery using assistant-adjusted endoillumination during 23-gauge sutureless vitrectomy for severe diabetic tractional retinal detachment (TRD) under noncontact wide-angle viewing system. MATERIALS AND METHODS: The trimanual sutureless vitrectomy under a wide-angle viewing system consisted of (1) a fourth-port microcannula in the inferior 6-o'clock position; (2) dynamic and specular illumination by an assistant-controlled light probe inserted through the fourth port; and (3) membrane dissection and bleeding control using two intraocular instruments. RESULTS: Six eyes of four patients who underwent trimanual diabetic vitrectomy were evaluated. Recurrent TRD was detected in one eye, and a second operation was performed. There were no intraoperative sclerotomy-related complications or postoperative hypotony, increased IOP, or endophthalmitis. Final anatomic and functional success was achieved in all six eyes. CONCLUSION: The trimanual technique is valuable for membrane dissection in severe diabetic TRD. The optimal and dynamic illumination provided a high-quality stereoscopic view under a wide-angle viewing system. Careful coordination between a surgeon and an assistant facilitates this technique.