25-Gauge Vitrectomy (original) (raw)
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TURKISH JOURNAL OF MEDICAL SCIENCES, 2014
Background/aim: To elucidate the early surgical advantages of a 23-gauge trocar combined with a one-directional valve system in transconjunctival pars plana vitrectomies. Materials and methods: Early surgical results of 432 eyes of 432 patients (190 female and 242 male) who underwent 23-gauge (23G) transconjunctival sutureless vitrectomies (TSV) were evaluated. Sixty-three patients out of 432 underwent a second operation, 29 of them underwent silicone oil extraction, and 34 had phacoemulsification surgery with the help of vitreous infusion. If any sign of leakage was observed after the withdrawal of the cannulae, a suture was applied at the conjunctiva-scleral opening site. Results: A total of 21 (4.8%) patients in the first operation and 7 (11.1%) cases in the second operation needed suture in at least 1 sclerotomy site. No one had intraoperative hypotony. On postoperative day 1, 37 initial surgery patients and 3 second TSV patients had hypotony; all of them resolved spontaneously 1 week after surgery. No one developed choroidal effusions or detachment. Intraocular pressure spikes more than 22 mmHg in day 1 occurred in 18 eyes after initial TSV; 6 of them had gas and 4 eyes had silicone tamponade. Conclusion: 23G TSV is an effective and safe procedure for both first vitreoretinal surgery and second intraocular surgeries in eyes that had TSV previously.
Indian Journal of Ophthalmology, 2014
To study the outcome of removal of retained intraocular foreign bodies (RIOFBs) via limbus using 23-gauge transconjunctival sutureless vitrectomy (TSV). Materials and Methods: In this prospective, non-comparative interventional case series, fourteen eyes of 14 patients fulfilling the inclusion criteria were enrolled. They underwent 23-gauge TSV for management of posterior segment RIOFB and reviewed at 1 day, 7 days, 6 weeks, 3, 6 and 12 months. Eyes with penetrating eye injury involving cornea or limbus (corneal injury not so severe to hinder vitrectomy), cataract associated with anterior and/or posterior capsular tear requiring cataract surgery and posterior segment RIOFB with minimal posterior segment involvement were included. Main outcome measures include success in removal of RIOFB without enlarging sclerotomy, ability to preserve capsular support, improvement in visual acuity and complications, if any. Results: All eyes underwent the successful RIOFB removal through limbal port without enlarging scleral ports. None of the eyes required suturing of the sclera, cornea or conjunctiva. Anterior capsular rim could be preserved in all eyes except one. Postoperatively follow up ranged from one year in 8, 6 months in 4 and 3 months in 2 eyes. The mean logMAR visual acuity at 3, 6, and 12 months showed significant improvement. There were no intraoperative complications. Postoperative complications include microscopic hyphema and loose blood in vitreous cavity in one eye. Conclusion: The advantages of 23-gauge TSV for removal of RIOFB may be passed on to select cases. RIOFB removal through limbal route obviated the need for scleral port enlargement and preserved capsular support for early visual rehabilitation.
A comparison of induced astigmatism in 20- vs 25-gauge vitrectomy procedures
Eye, 2009
Introduction Surgically induced astigmatism is an unwanted variable that can lead to poorer visual and refractive outcomes in patients undergoing vitrectomy even when a technically precise procedure has been performed. This study assesses the difference in surgically induced astigmatism (SIA) between the traditional 20-gauge vitrectomy and the newer 25-gauge sutureless technique by comparing pre-and post-procedure keratometry readings. Method The study is a retrospective consecutive case series of vitrectomies performed by a single surgeon. There were a total of 47 patients, eight with bilateral procedures, 24 who underwent the 20 gauge, and 31 who had the 25-gauge procedure. Patients were excluded for corneal altering pathology or scleral buckling procedures. Vector analysis of pre-and post-vitrectomy readings was performed using Alpin's method, facilitated by the ASSORT program version 4.1. Results Mean time at which post-operative keratometry readings were taken was 3.9 months (1-36). Mean astigmatism at presentation was 0.63 D and 0.92 D and at postsurgically follow-up 1.14 D and 0.91 D (20 and 25 gauge, respectively). Mean SIA was 0.66 D (SD ¼ 0.8 D) for the 20-gauge group and 0.27 D (SD ¼ 0.23 D) for the 25 gauge (P ¼ 0.037). The calculated figure of SIA variability representing the 95% CI for the maximum amount of SIA for each procedure was 2.26 D and 0.73 D for the 20-and 25-gauge procedure, respectively. Conclusions The study shows that the 25-gauge technique involves a statistically significant reduction in the amount of SIA. This can ultimately lead to a better visual and refractive outcome for the patient.
Pakistan journal of ophthalmology, 2013
To evaluate the safety of 3 port pars plana 23 gauge transconjunctival sutureless vitrectomy for vitreoretinal diseases. Material and Methods: A prospective study was conducted at the Institute of Ophthalmology, Mayo Hospital Lahore from July 2010 to December 2010. All patients were admitted in the eye ward from the outpatients department. Total 30 patients were included in the study. Male to female ratio was 70:30. Mean age of patients was 45.5 years. Those included had idiopathic epiretinal membrane (ERM), diabetic vitreous hemorrhage, traumatic vitreous haemorrhage, vitreous haemorrhage secondary to Eale's disease, diabetic macular edema, macular hole, Diabetic (tractional retinal detachment) TRD and dislocated lens. Outcome measures were recorded at baseline, 1 day, 1 week and 1 month, 2 months and 3 months post operatively. Applanation tonometery, intra & post-operative complications, ancillary tests such as ocular coherence tomography (OCT) and ultrasound were done as required. Results: Intra-operative complications noted were retinal tear 9% (2.7 patients), lens touch 4% (1.2 patients), sclerotomy leak requiring stitches 35% (10.5 patients), conjunctival hemorrhage 31% (9.3 patients), cannula slippage 13% (3.9 patients), entry site break 4% (1.2 patients) and retinal touch 4% (1.2 patients). First day post-operative complications were hypotony 20%, conjunctival inflammation 30%, mild eye discomfort 23.3% & corneal edema 13.3%. No complication was noted on 7 th post operative day. Conclusion: This study showed that procedure is safe and can be adopted in different vitreoretinal procedures. It is minimally invasive surgical technique that enhances the postoperative recovery and outcomes by simplifying the surgical procedure. T