Related Experiment Video
Updated: Aug 6, 2026
An Ex Vivo Tissue Culture Model for Fibrovascular Complications in Proliferative Diabetic Retinopathy
Published on: January 25, 2019
Reverse Swiss Roll technique for diabetic vitreous membranes
Shilpi Narnaware1, Prashant Bawankule1, Suraj Sontakke1
1Sarakshi Netralaya, Nagpur, Maharashtra, India.
Background:
Diabetic membranes are always a challenge for a surgeon because of sticky nature and chances of iatrogenic break while removing.
Purpose:
To demonstrate a safe reverse swiss roll technique to dissect diabetic vitreous membranes.
Synposis:
Approaches and techniques for membrane dissection are segmentation, delamination and en-bloc dissection using various types of instruments and illumination. With vitreous cutte, picks and scissors, surgical steps are traditionallu performed by using classic lift and shave technique. After identifying the plane, tissue is lifted and then cut, which puts the retina at risk of break because of traction and active suction. Such a threat can be reduced by placing the cutter above the membrane thereby having the membrane itseld acting as a protective cushion to the retina. Port here, unlike lift and shave technique, doesn't face the edge of membrane but is exactly 180 degree opposite and membrane curls into port because of suction. Also, hemostasis is maintained by continuous aspiration and cutting as the instrument is moved side to side, retracting from the edge.
Highlights:
Reverse swiss roll technique is safer compared to lift and shave because of the safety cushion of the membrane between the port and the retina. There is inherently less chances of retinal break because the active suction from the port is directed away from the retina. The technique also minimises traction and localised pull on the atrophic macula.
Video Link:
https://youtu.be/WNnSsP69ZLw.
Insights
Diabetic vitreous membranes are challenging due to their sticky nature. A new reverse swiss roll technique offers a safer method for membrane dissection, minimizing retinal damage.
Area of Science:
- Ophthalmology
- Surgical Techniques
Background:
- Diabetic membranes pose surgical challenges due to their adhesion and risk of iatrogenic breaks.
- Current membrane dissection techniques carry risks of retinal damage from traction and suction.
Purpose of the Study:
- To demonstrate a safe reverse swiss roll technique for dissecting diabetic vitreous membranes.
- To reduce the risk of iatrogenic retinal breaks during membrane removal.
Main Methods:
- The reverse swiss roll technique involves placing the surgical instrument's port above the membrane.
- Suction is applied, causing the membrane to curl into the port, away from the retina.
- This contrasts with the 'lift and shave' technique, reducing direct traction on the retina.
Main Results:
- The reverse swiss roll technique provides a safety cushion, minimizing retinal break risk.
- Active suction is directed away from the retina, enhancing safety.
- The technique reduces traction, particularly beneficial for atrophic maculas.
Conclusions:
- The reverse swiss roll technique is a safer alternative for diabetic membrane dissection.
- This method enhances surgical safety by minimizing iatrogenic retinal injury.
