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22nd International Congress of German Ophthalmic Surgeons

18. to 21.06.2009, Nürnberg

The “snowstorm technique”: triamcinolone suspension in the vitrectomy infusion bottle

Meeting Abstract

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  • Enrico Bertelli - Zentralkrankenhaus Bozen, Augenabteilung, Bozen, Italien
  • Paolo Pelanda - Zentralkrankenhaus Bozen, Augenabteilung, Bozen, Italien

22. Internationaler Kongress der Deutschen Ophthalmochirurgen. Nürnberg, 18.-21.06.2009. Düsseldorf: German Medical Science GMS Publishing House; 2009. Doc09docVI 3.4

doi: 10.3205/09doc081, urn:nbn:de:0183-09doc0818

Published: July 9, 2009

© 2009 Bertelli et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.



Purpose: Triamcinolone Acetonide (TA)-assisted vitrectomy was first reported in 2000, and is becoming increasingly popular among vitreoretinal surgeons. Vitreous staining properties of TA suspension in the conventional use improve visualization of vitreous fibers and vitreoretinal interface. However they offer limited information about vitrectomy flow, since dilutions reported in the literature rapidly sink onto the posterior pole after injection. Constant visualization of vitrectomy flow may increase safety of intraocular maneuvers with the vitrectomy handpiece. With the aim of visualizing vitreous flow we chose to inject TA suspension into the BSS infusion bottle.

Methods: In the first 8 vitrectomy cases 80 mg. TA suspension were injected into the BSS infusion bottle after 30 min. sedimentation in the syringe and removal of the overfloating fluid. In further 10 cases (for a total amount of 18) 60 mg (1 and ½ vials) were used, since the staining with this dilution was also considered adequate. The bottle was shaken and then connected to the vitrectomy system immediately before starting vitrectomy. Vitrectomy was carried out in all cases with a 23 G transconjunctival vitrectomy system (DORC, Zuidland, Holland). A complete fluid-air or fluid-gas exchange was carried out at the end of each procedure.

Results: After TA injection BSS fluid became opaque in the bottle. In the posterior chamber TA suspension appeared as a fine “snowstorm”, not impairing the visualization of the fundus. Vitreous staining properties of this highly diluted TA suspension were inferior to the one obtainable with conventional direct injection through sclerotomies of denser TA suspensions. However constant and direct visual information could be achieved about vitrectomy flow and turbulence at the tip of the vitrectomy probe, making vitrectomy safer, especially when approaching the vitrous base. With the help of the light probe, identification of the vitreous edge could also be obtained indirectly, beyond the enlighted turbulence in the BSS fluid. No complications related to the technique could be observed.

Conclusions: Staining of the infusion bottle with TA suspension allowed visualization of BSS flow at the tip of the vitrectomy probe and was helpful in vitrectomy of the vitreous base. Further study is warranted in this field.