Non-aspiration Technique to Induce Posterior Vitreous Detachment in Minimum Incision Vitrectomy System

Complete removal of the posterior hyaloid is an important procedure in vitrectomy for various vitreoretinal disorders. Although posterior vitreous detachment (PVD) can be usually induced by active aspiration of vitreous gel, it is difficult in cases where the posterior hyaloid attaches tightly to the retina, especially in minimum incision vitrectomy systems (MIVS) due to the smaller apertures of the instruments. We describe a novel technique of creating PVD without aspiration. In this method, a break in the vitreous cortex is initially made at the posterior precortical vitreous pocket using a diamond dusted membrane scraper. Once a break in the vitreous cortex is induced, the break is extended by continuing the same manipulation. Detachment of the posterior vitreous gradually progresses by the influx of irrigation fluid from the break into the space between the posterior vitreous and the retina. Subsequently, the scraper is inserted under the detached posterior hyaloid from the break in the cortical vitreous, and is lifted upward to complete the PVD. Complete PVD is confirmed by observation of the Weiss ring in front of the retina. Using this technique, PVD can be achieved in vitrectomies using MIVS, even when the posterior hyaloid attaches tightly to the retina.