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Four-Port Bimanual Vitrectomy in Fibrovascular Membrane Removal

Removal of fibrovascular membranes from the retina is essential for treating severe proliferative diabetic retinopathy but has remained difficult. The most critical part of vitrectomy for proliferative diabetic retinopathy involves meticulous sectioning and removal of fibrovascular membranes that may be associated with significant complications. Membrane peeling with several scissors or special instruments, maneuvered with one hand or bimanually, has been used. Complicated situations encountered during vitreoretinal operations can be better mastered using bimanual techniques than with conventional single-handed methods. For example, tight and wide adhesions between vitreous and retina should be separated using bimanual delamination techniques. Hence, using a bimanual approach during vitrectomy for fibrovascular tissue removal is especially desirable in eyes with extensive fibrovascular proliferation. A variety of specially designed instruments have been used to facilitate bimanual membrane dissection in previous studies. However, these techniques all require special equipment and instruments. Now, we describe a new simple technique without additional equipment and instruments to facilitate bimanual vitreous surgery in proliferative diabetic retinopathy.