To introduce the surgical technique using light pipe guard for cataract surgery in combined vitrectomy in patients with poor red reflex due to vitreous opacity.


Patients with coexisting cataract who were scheduled for 23-gauge pars plana vitrectomy were enrolled in this study.

Instrument & Design:

The lengths of light pipe and microcannula in 23-gauge Alcon Constellation system are 30mm and 5mm, respectively. In order to minimize the risk to the retina, we have restricted the instruction of the light pipe to 5mm in vitreous cavity by covering the proximal pipe with a 20mm length of metallic guard. Considering sterilization and reuse, light pipe guard should be made with stainless steel. For the application to variable size of instruments currently used (20, 23, 25 and 27 gauge), the caliber of light pipe guard should be bigger than 20-gauge. To meet these conditions, we used the guide needle in 16-gauge intravenous catheter. We cut both side of guide needle to make 20mm length.

Surgical Technique:

Retrobulbar anesthesia was used in all involved cases. First, 3 sclerotomies with insertion of microcanular were conducted 3.75mm from the corneal limbus. In case of poor red reflex, such as vitreous hemorrhage, a conventional 23-gauge illuminator was inserted into the microcannula with light pipe guard. All phacoemulsification and vitrectomies were done with the Alcon (Fort Worth, Texas, USA) constellation vitrectomy system using 23-gauge instruments and trochars. All procedures were performed by one surgeon (K.S.I) with training residents.


Combined vitrectomy and cataract surgery was performed in 10 patients using light pipe guard. The causes of vitrectomy were due to vitreous hemorrhage (proliferative diabetic retinopathy in 8 eyes 7 patients), vitreous opacity (Masquerade syn. 1 eye, RRD in 2 eyes 2 patients). All cases of cataract surgery were performed uneventfully except one case. Posterior capsular was ruptured in this case during phacoemulsification.


Chandelier endoillumination or lens capsule staining was previously introduced in poor red reflex. However, Chandelier endoillumination require more sclerotomies and separate illumination system, and there is endothelium toxicity when capsule staining. Light pipe guard can offer safety and convenience. In current report, we introduce a new practical application of light pipe guard in combined cataract and vitrectomy.

Contact Details:

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