Chirag Bhatt, Aniruddha Maiti, R. C. Paul, P. K. Chatterjee, Aditya Kelkat, Abhijit Chattopadhyay (Kolkata, India)

Advantages:

Diabetic retinopathy is one of the leading causes of blindness in the world. Vitrectomy may not only remove vitreous hemorrhage but also prevent or relieve traction on the retina from contraction of the fibrovascular membranes that characterize severe proliferative diabetic retinopathy. In advance proliferative diabetic retinopathy successful removal of fibrovascular membrane is many times associated with bleeding and trauma to retina when we handle the situation by traditional 3-port pars plana vitrectomy. The better alternative is to use bimanual vitrectomy with chandelier’s light in place and using two instruments to dissect, delaminate and remove firmly adherent diabetic membranes with least trauma to viable retina.

Methods:

This video shows a method of managing diabetic membranes with 23 Gauge vitrectomy using high magnification BIOM lens and with chandelier’s light in advance diabetic cases. With chandelier’s light in place one can use combination of scissors and forceps or cutter and forceps or diathermy and flute needle together to dissect membrane with minimum trauma.

Effectiveness / Safety:

Working bimanually help to avoid damage to viable retina, working under high magnification help us to define plane and edges of membrane and chances of iatrogenic breaks and bleeding are less which are two most frightening conditions during vitrectomy.

Take home message:

Bimanual vitrectomy is safer way to handle complicated membranes of diabetic retinopathy with least trauma to retina.