Temporal Vitrectomy: A new approach to retina surgery

Optimizing surgeon positioning and instrumentation relative to the eye is critical for successful ophthalmic microsurgery.

Positional preferences have evolved over time with changing instrumentation and operative techniques. Most cataract surgeons now perform phacoemulsification from a temporal rather than superior position.

Pars plana vitrectomy (PPV), however, is still typically performed with the surgeon seated superiorly. Instruments are inserted through two sclerotomies in the superonasal and superotemporal sclera while an infusion cannula is placed inferotemporally.

We considered whether a temporal approach might be advantageous in selected small-gauge PPV cases. Findings from our study were published in the journal RETINA.

Surgeon surveys indicated significant advantages with a temporal approach for each anterior segment indication, no significant differences in performing the basic surgical steps of PPV, and relative ease of adopting this technique.

Performing PPV from the temporal position seems to be advantageous in cases combining posterior and anterior segment surgery such as cataract extraction, pupillary membrane dissection, preservation of superior conjunctival blebs, and trimanual vitrectomy.