Intraoperative induction of posterior vitreous detachment without staining of the posterior hyaloid membrane as a stage of surgical treatment of vitreoretinal pathology
Authors:   S. Fyodorov Eye Microsurgery Federal State Institution, Kaluga Branch, Kaluga, Russian Federation, Shilov N.M. , Tereshchenko A.V. ,   S. Fyodorov Eye Microsurgery Federal State Institution, Kaluga Branch, Kaluga, Russian Federation,   S. Fyodorov Eye Microsurgery Federal State Institution, Kaluga Branch, Kaluga, Russian Federation, Trifanenkova I.G. ,   S. Fyodorov Eye Microsurgery Federal State Institution, Kaluga Branch, Kaluga, Russian Federation,   S. Fyodorov Eye Microsurgery Federal State Institution, Kaluga Branch, Kaluga, Russian Federation, Yudina N.N. ,   S. Fyodorov Eye Microsurgery Federal State Institution, Kaluga Branch, Kaluga, Russian Federation, Erokhina E.V. ,   S. Fyodorov Eye Microsurgery Federal State Institution, Kaluga Branch, Kaluga, Russian Federation, Plakhotniy M.A. ,   S. Fyodorov Eye Microsurgery Federal State Institution, Kaluga Branch, Kaluga, Russian Federation, Novikov S.V. ,   S. Fyodorov Eye Microsurgery Federal State Institution, Kaluga Branch, Kaluga, Russian Federation
Published: August 2023

Purpose. To develop a technology for intraoperative induction of posterior vitreous detachment without staining the posterior hyaloid membrane and evaluate its clinical effectiveness. Material and methods. The study included 10 premature infants (18 eyes) with stages 3 (8 eyes) and 4a (10 eyes) of active ROP and 70 adult patients (70 eyes) with primary penetrating macular holes, 48 of them with medium (diameter 250–400 µm) and 22 large holes (more than 400 µm in diameter). According to the indications, all patients underwent vitreoretinal surgery using the technique of intraoperative induction of posterior vitreous detachment (PVD) developed in the Kaluga branch of the S. Fyodorov Eye Microsurgery Federal State Institution. A vitreotome is used, while dyes are not used during vitreoretinal surgery. Results. It was possible to initiate the posterior vitreous detachment intraoperatively without the use of dyes and additional instruments for all patients included in the study. There were no complications at this stage of the operation in any case. In children with active ROP, posterior vitreous detachment was induced using the tip of a vitreotome, the posterior hyaloid membrane was separated from the adjacent retina almost along its entire length, and the maximum removal of the vitreum was performed. This was achieved in all 18 eyes. In adult patients with macular rupture after successful induction of posterior vitreous detachment, in all 70 cases it was possible to perform the operation completely, with the formation of the inner limiting membrane flap and the closure of the macular rupture. Conclusion. The developed technique for intraoperative induction of posterior vitreous detachment is effective in separating the posterior hyaloid membrane and posterior cortical layers of the vitreous body from the retina, reduces the duration and trauma of the operation, does not require special instruments or dyes, and can be successfully used as the initial stage of vitreoretinal operations to create access to the subsequent stages of surgery treatment. Key words: induction of posterior vitreous detachment, retinopathy of prematurity, macular rapture