Non-vitrectomizing surgery for idiopathic macular pucker using a 25-gauge synergetics high-flow infusion with a 27-gauge light (Photon™ II, Synergetics USA, Inc.)

Abstract

To describe a case of macular pucker treated by non-vitrectomizing vitreoretinal surgery using a 25-gauge high-flow infusion cannula with a 27-gauge illumination source (Photon II; both from Synergetics USA Inc., O'Fallon, MO). A 42-year-old man complaining of visual reduction and metamorphopsia was referred to the Vitreoretinal Surgery Unit, where he underwent full ophthalmic examination. Best corrected visual acuity (BCVA) at baseline was 0.5 in the left eye (LE) and 1.0 in the right eye. He was diagnosed with epiretinal membrane (ERM) in the LE. The surgical procedure envisaged two-port sclerotomy, one for the infusion line of the 27-gauge Photon II light source, the other for the 25-gauge trocar in the superotemporal quadrant. The ERM was removed with a 25-gauge disposable forceps. The infusion line was placed for safety in the event of additional intraocular pressure being needed, but was not required. The 27-gauge light source afforded good visualization of the posterior pole and the ERM. At 12 months, the patient's BCVA had improved to 1.0, and his cataract has not progressed. A 25-gauge infusion line used with the photon illumination may further improve non-vitrectomizing surgery, minimizing risk and optimizing outcome. Further trials are required to validate these preliminary observations.