Bimanual anterior vitrectomy using a 25-gauge high-speed cutter to manage vitreous loss during phacoemulsification.

We examined the usefulness of bimanual anterior vitrectomy with a 25-gauge high-speed cutter and infusion cannula for managing vitreous loss during phacoemulsification. Three eyes underwent phacoemulsification under topical anesthesia, during which, posterior capsule rupture occurred, resulting in vitreous loss and residual nuclear fragments. A 25-gauge high-speed cutter (2,500 cuts/min) and a 25-gauge infusion cannula were inserted into the 3 and 9 o'clock ports. Anterior vitrectomy was performed by employing a bimanual technique. A viscoelastic substance and infusion cannula prevented nuclear fragments from falling into the vitreous. The cutter allowed the easy excision of nuclear fragments and sharp excision of the vitreous. The vitreous incarcerated in the iris at 12 o'clock was removed by manipulating the cutter like a spatula. Bimanual anterior vitrectomy, using a 25-gauge high-speed cutter and infusion cannula, allows effective excision of the lost vitreous, while preserving a closed anterior chamber under topical anesthesia.