Novel Technique of 23G Pars Planar Vitrectomy (TPPV) with Alcon Centurion Silver System Gravity -FMS (ACenSS) and ACenSS Vitrectomy Probe (23G) with an External Light Source in Teaching Hospital Rathnapura Sri Lanka

Dual pneumatic 23G vitrectomy cutters of both Alcon Constellation Vision System (AConsVS) and ACenSS have cut rates of 5000 cpm. Aims: To report a novel technique of using ACenSS 23G Vitrectomy cutter for trocar surgery with an external light source in Teaching hospital Rathnapura Sri Lanka from 01/03/2022 to 30/09/2022. Methods: 23G Alcon light probes were used with Retikare (ICON Medicare Tamil Nadu India) external light source for endoillumination. Infusion pressure was set at 65cmH2O (47.81 mmHg) and infusion line connected to eye through a 3 ways tap. ACenSS-GFMS aspiration line connected to aspiration line of vitrectomy probe. Cryopexy used to seal retinal tears as no endolaser facility. Volk surgical corneal lenses with Zeiss Lumera I microscope provided the viewing. ACenSS foot pedal was programmed to 3 modes of vitrectomy with navigation, cutter on/ off function and on/pause of continuous irrigation. A gravity driven another infusion line is used to keep the infusion when endo diathermy is used. Results: When working on maximum cut rate of the ACenSS GFMS (5000 cpm) for long duration machine automatically stops and a restart with reprime needed. Therefore, cut rates were set at a lower rate to work without interruption (core vitrectomy2000 cpm, peripheral trim- 3000cpm and for epinucleus removal 4000 cpm). No retinal traction or ridging of retina was observed at peripheral trim. Total of 210 TPPVs were performed with this technique. Conclusions: 23G TPPV with ACenSS using an external light source is a simple, safe and a cost-effective technique with equal outcome to AConsVS.