'Stop-and-Slide' technique for trocar insertion during lens-sparing vitrectomy for retinopathy of prematurity

The modern-day trocar cannula systems meant for adult eyes pose a challenge in infant's eyes with stage 4 retinopathy of prematurity (ROP) undergoing lens-sparing vitrectomy. This is primarily owing to the length of the trocar, globular lens, smaller axial length, and anteriorly displaced retina. We describe an inexpensive modification of the technique of trocar insertion in such cases wherein the trocar is inserted partially till the cannula impinges the sclera and thereon, the cannula slides over the trocar into the vitreous cavity. This obviates the need for complete insertion of the trocar into the vitreous cavity and hence limits the chances of inadvertent injury to the crystalline lens or the anteriorly lifted retina. We have experience in using this technique in 52 eyes of 44 infants over the past 2 years with no episode of iatrogenic lens touch or retinal break during trocar insertion.