Endothelial Keratoplasty by Amar Agarwal Terry Kim

Author:Amar Agarwal,Terry Kim
Language: eng
Format: epub
Publisher: Thieme Medical Publishing Inc.
Published: 2017-01-19T00:00:00+00:00

10 Trocar Anterior Chamber Maintainer: An Improvised New Concept for Infusion and Endothelial Keratoplasty

Priya Narang and Amar Agarwal

10.1 Concept

The merits of a closed chamber infusion system that helps to maintain the tonicity of the globe throughout intraocular surgery cannot be overstated. Maintenance of a deep anterior chamber (AC) is a prerequisite for safe, smooth performance of intraocular surgery because it prevents inadvertent and harmful touch to the corneal endothelium and also to various other structures. For the same reason sodium hyaluronate was introduced and it served as a major breakthrough for all anterior segment intraocular surgeries.1,2,3 Although the use of viscoelastic also plays an important role, its use for maintenance of an AC in corneal surgeries is not a prudent idea, more so with endothelial keratoplasty (EK) procedures.

Blumenthal devised a simple and practical method for maintaining the AC with a device that he called the anterior chamber maintainer (ACM), which was made from a 21-gauge scalp vein (**butterfly**) set. Since the introduction of an ACM there have been various modifications to the ACM to suit the surgical condition of the eye. The ACM4,5,6 and trocar cannula are the most common methods employed for infusion by anterior segment and posterior segment surgeons, respectively. Introduction of the trocar cannula was a monumental advance in ophthalmology because it allowed, for the first time, controlled access to the posterior segment of the eye. It is also an integral part of modern pars plana vitrectomy for maintaining infusion in the eye.7,8,9,10,11 A 23-gauge (0.6 mm), 25-gauge (0.5 mm), or 27-gauge (0.4 mm) trocar system can be introduced transconjunctivally through the tenon’s layer to expose the sclera. Instead, trocars are placed through the conjunctiva and sclera to afford access to the vitreous and also to maintain infusion in the eye. We designed a trocar AC maintainer (TACM) to help surgeons achieve better infusion (► Fig. 10.1). The TACM can be used by anterior segment surgeons for air/fluid infusion into the eye.12

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