Purpose: To describe a novel vitrectomy approach that enables the surgeon to perform bimanual maneuvers endoscopically. Methods: Cases were evaluated. Results: Two patients with opacified penetrating keratoplasties were found to have macula-off retinal detachments along with extensive proliferative vitreoretinopathy and epiciliary membranes. Both patients underwent successful retinal detachment repair, dissection, and membrane peel via endoscopy-assisted pars plana bimanual vitrectomy using our technique, while avoiding additional resource-intensive procedures. The approach uses a 23-gauge pars plana vitrectomy system, 23-gauge ophthalmic endoscope, 70 silicone sleeve, and surgical assistant. The silicone sleeve is placed over the endoscopy probe to prevent inadvertent advancement and is then held by the assistant, allowing the surgeon to maneuver both hands simultaneously. Conclusions: Our bimanual surgical technique eliminates a key surgical limitation of endoscopic pars plana vitrectomy, allowing approaches that were not endoscopically feasible before. Larger prospective studies are needed to better understand the risks and benefits of bimanual endoscopic vitrectomy.
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