25-gauge System Research Articles

Autologous-Fibrin Induction: A Novel Approach for Sutureless Sclerotomy Closure in Pars Plana Vitrectomy

Purpose This study presents a novel sutureless closure approach for sclerotomies following pars plana vitrectomy (PPV) and assesses its efficacy and safety. Methods A total of 142 eyes were included in the study. PPV procedures were performed using 23-gauge (23 G) or 25-gauge (25 G) systems. Preoperative characteristics, intraoperative findings, and postoperative outcomes were documented. Results The cohort included 80 males and 62 females (mean age: 60.4 ± 12 years), primarily undergoing surgery for retinal detachment (59%). Among the patients, 87% underwent 25 G PPV (35% three-port, 52% four-port), while 13% underwent 23 G PPV (12% three-port, 1% four-port). Gas tamponade was administered in all cases, with perfluoropropane used in 45.7% of instances, sulfur hexafluoride in 29.5%, and air in 24.6%. Spontaneous closure was observed in 9.4% (47 of 501) of sclerotomies, autologous-fibrin induction approach successfully closed 75.8% (380 of 501) of the sclerotomies (83.7% of leaking sclerotomies) and 14.7% (74 of 501) of sclerotomies needed sutures. Visual acuity improved postoperatively, and first-day hypotony rate was 6.3%. Importantly, no serious complications such as choroidal detachment or endophthalmitis were observed during the postoperative period. Conclusion The autologous-fibrin induction offers a simple, cost-efficient, and reliable approach for sutureless sclerotomy closure in PPV, with promising outcomes.

Transcorneal Vitrectomy in Eyes with Regressed Retinoblastoma

Purpose: Current treatments for retinoblastoma facilitate globe salvage but can result in vitreoretinal disorders that may require surgery. There is controversy on surgical approaches in eyes with retinoblastoma. Here we describe a transcorneal vitrectomy approach that avoids the use of chemotherapy or cryotherapy. Methods: Retrospective chart review was performed on five consecutive patients with regressed retinoblastoma for >12 months (Group D/ct2b) at Children’s Hospital Los Angeles who had vitrectomy between November 2022 and December 2023. Results: Five patients underwent 8 vitrectomies for various indications including IOL fibrosis, vitreous hemorrhage, cataract, retinal detachment, and silicone oil removal. Mean age at first vitrectomy was 6.2 years (range: 2-9 years); mean time from last retinoblastoma treatment was 50.4 months (range: 20-82 months). Radially oriented corneal incisions were made with the 23-gauge or 25-gauge trocar system and the Versa HD LenZ (Oculus) was utilized with the RESIGHT (Zeiss) for top-down visualization. Neither chemotherapy nor cryotherapy were utilized. Wounds were sutured parallel to the limbus with 10-0 polyglactin 910 suture (Vicryl, Ethicon), and a final water rinse was performed to lyse any potential retinoblastoma cells. Surgical objectives were achieved, vision remained stable, and no retinoblastoma spread was noted with a mean follow-up of 7.6 months (range: 3-12 months). Conclusions: This vitrectomy technique for eyes with regressed retinoblastoma permits top-down viewing with the Versa HD LenZ. Radial placement of corneal wounds avoids suturing through the uveal tract, and a postsurgical water rinse lyses any retinoblastoma cells. This approach may obviate the need for chemotherapeutics or cryotherapy.

AN UNUSUAL WAY TO INDUCE THE CLOSURE OF A POSTERIOR POLE RETINAL TEAR IN A TRAUMATIC RETINAL DETACHMENT

Purpose. The authors present a case of both traumatic subluxated lens with zonular dialysis and a traumatic retinal detachment with posterior retinal tear. Methods. Some fragments have dropped into the vitreous chamber during phaco-emulsification and one of them has even passed through the retinal tear and has been removed from the subretinal space. A 3-piece intraocular lens with a tension ring supporting the capsular bag was implanted. Pars plana vitrectomy with accurate vitreous base shaving was approached by 23-gauge system. Subretinal fluid was removed by a complete fluid-air exchange. A large macular internal limiting membrane (ILM) peeling was performed and the posterior retinal tear was covered by multiple inverted ILM flaps. Results. Postoperatively, retinal reattachment was achieved, the retinal break was flat. The ILM flaps were well positioned within the retinal tear and covered the preoperatively bared RPE. Conclusions. The surgical treatment of injuries after a blunt ocular trauma are not standardizable. In this case surgical outcomes suggest the effectiveness of the surgeon’s intraoperative unusual maneuvers.

Comparisons of surgical outcomes after epiretinal membrane peeling in the myopic eyes with long to that with normal axial length.

To compare the outcomes of vitrectomy with removal of an idiopathic epiretinal membrane (ERM) in the myopic eyes with long axial length (AL) to that in the eyes with normal AL. This was a retrospective, observational, case-control study. Fifty-six eyes of 56 patients with an idiopathic ERM were studied. Twenty-eight of these eyes had an axial length longer than 26.0 mm (Group A), and the other 28 eyes had axial lengths < 26.0 mm (Group B). The age and visual acuity of the two groups were not significantly different. All subjects were treated by vitrectomy and peeling of the ERM with a 25- or 27-gauge system. The postoperative best-corrected visual acuity (BCVA) and optical coherence tomographic findings were determined at 3 and 6 months postoperatively. The mean BCVA improved from 0.35 ± 0.25 to 0.15 ± 0.25 logMAR units in the eyes with the long AL and from 0.35 ± 0.25 to 0.10 ± 0.21 logMAR units in the eyes with normal AL at 6 months postoperatively (both P < 0.001). The postoperative BCVA was not significantly different between the two groups at 6 months (P = 0.221). The central macula was thinner in the eyes of Group A than Group B (P < 0.001). The restorations of the ellipsoid zone and the external limiting membrane were observed in both groups, but the interdigitation zone was less frequently restored in Group A (P < 0.001). Vitrectomy with the removal of the epiretinal membrane is effective in attaining a good BCVA even in the myopic eyes with long AL.

Comparison of Characteristics and Clinical Outcomes in 27-Gauge versus 23-Gauge Vitrectomy Surgery.

PurposeTo compare characteristics, clinical outcomes and complication profiles of a cohort of patients undergoing 27-gauge versus 23-gauge vitrectomy surgery at a tertiary medical center in the Middle East.MethodsThis is a retrospective comparative study of indication-matched patients undergoing 27-gauge versus 23-gauge pars plana vitrectomy for a set of predetermined diagnoses. Data including indications for surgery, clinical exams, visual outcomes, and complications were documented and analyzed.ResultsA total of 22 patients who had 27-gauge pars plana vitrectomy were compared with 44 patients who had 23-gauge surgery for matched indications by a single retina surgeon. Mean follow-up was 14 months after surgery. Indications included macular pucker, macular hole, and vitreous hemorrhage. Both the rate of hypotony at postoperative day 1 and the need for sclerotomy stitching at the end of surgery were significantly more frequent in 23-gauge compared to 27-gauge cases (25% in 23-gauge compared to 0% in 27-gauge (p=0.012) and 18% in the 23-gauge compared to 0% in the 27-gauge (p=0.045), respectively). The mean duration of surgery was similar among groups (35 mins in the 27-gauge group versus 39 mins in the 23-gauge group (p=0.116)), and all eyes achieved anatomic success. In the 27-gauge group, best-corrected visual acuity improved from a mean of 20/90 at baseline to a mean of 20/40 at 1 month (p=0.005) and in the 23-gauge group from a mean of 20/95 to 20/50 (p=0.001) with no statistical difference between the groups.ConclusionIn this cohort of patients undergoing vitrectomy at a tertiary eye center, the rate of hypotony and the need for sclerotomy suturing were significantly less in the 27-gauge group versus the 23-gauge group. Surgical outcomes were similar in both study groups. The use of the novel 27-gauge instrument system is useful in selected vitreoretinal diseases and appears comparable to the widely used 23-gauge system.

Alternative technique for insertion of Eva Dorc® infusion cannula in vitreoretinal surgeries

Abstract This paper provides a fast and inexpensive technique to prevent slippage of the infusion cannula from the EVA DORC® 27-gauge system. After the usual retrobulbar anesthesia, antisepsis and asepsis, a 2% hydroxypropyl methylcellulose drop is placed around the infusion cannula in the trocar to hold it in position. This technique prevents the slippage of the infusion cannula and both the surgical time and creation of the first sclerotomy in the eye can be shortened slightly. Alternative technique for insertion [...]

Analysis of Changes in Corneal Topography after 27-Gauge Transconjunctival Microincision Vitrectomy Combined with Cataract Surgery.

Purpose To investigate changes in the corneal shape before and after vitrectomy, over a period of time, using a 27-gauge system. Methods Forty-five eyes underwent a combination of cataract surgery and vitrectomy. The surgeries were performed using a 27-gauge transconjunctival vitrectomy system, in which the corneal topography could be performed up to three months after the surgery. The surgeries were performed for an epiretinal membrane in 11 eyes, a macular hole in 14 eyes, and rhegmatogenous retinal detachment in 20 eyes. All of the surgeries were performed by the same surgeon, and in all cases, a 4-port 27-gauge vitrectomy device was used. Cataract surgery in all patients was performed with a 2.4 mm corneoscleral incision at 11 o'clock. The surgeries were performed without suturing the operative wound in all cases. Corneal topography was performed using a TMS-4 topographer (Tomey Corporation, Tokyo, Japan). The examinations were performed the day before and 1 day, 1 week, 1 month, and 3 months after the surgery. The results of corneal topography for the spherical, regular astigmatic, asymmetric, and high-order irregular astigmatic components were compared before and after surgery. Results No significant differences were seen in any of the components in the epiretinal membrane group, but significant differences were seen in the asymmetric components and the high-order irregular astigmatic components between the macular hole and rhegmatogenous retinal detachment groups (p < 0.05). There were no significant changes in intraocular pressure on any measurement time in the postoperative period compared to preoperative intraocular pressure. Conclusion Irregular astigmatism was seen after surgery when 27-gauge vitrectomy with a 4-port system was performed together with cataract surgery with a 2.4 mm incision.

Visual Outcome of Pars Plana Vitrectomy for Treatment of Premacular Hemorrhage

Background: premacular hemorrhage can lead to painless loss of central vision. Several modalities of treatment have been described in previous reports. Purpose: to evaluate the visual outcome after pars plan vitrectomy (PPV) for treatment of premacular hemorrhage of different etiology. Patients and methods: A series of retrospective study 17 eyes of 17 patients presented with premacular hemorrhage due to different pathologies. Complete ophthalmic evaluation was done including visual acuity (VA), intraocular pressure (IOP), anterior segment examination, slit lamp biomicroscopy, fundus photography± fluorescein angiography (FA), and ocular ultrasound ± biometry. PPV was performed using 23gauge system with proper tamponade ± Phaco with PCIOL.No intraoperative lens touch or iatrogenic retinal tear has been recorded. Results: BCVA was improved from CF 50 cm in2 cases, hand movement (HM) in 15 cases to 0.1 (Log MAR) in 2 eyes (11.76%), 0.3 in one eye (5.88%), 0.4 in 5 eyes (29.41%), 0.6 in 3 eyes (17.64%), 1.00 in 3 eyes (17.64%), (3/60) in 2 eyes (11.67%), CF (1/60) in one eye (5.88%). No serious complications weredetected. Conclusion: PPV is a beneficial surgical treatment for premacular hemorrhage of different pathologies ensuring rapid visual recovery. The visual outcome is an encouraging and the complications are comparable to other studies.

Comparison of postoperative ciliary body changes associated with the use of 23-gauge and 20-gauge system for pars plana vitrectomy

BackgroundTo compare the ciliary body changes associated with the use of 23-gauge (23G) and 20-gauge (20G) systems for pars plana vitrectomy.MethodsA total of 60 patients (60 eyes) with idiopathic epiretinal membrane who were scheduled for surgical treatment were selected and randomly assigned to 20G group or 23G group. Time required for incision making, vitrectomy, and incision closure was compared between the two groups. Changes in ciliary body were evaluated by ultrasound microscopy (UBM). Anterior chamber inflammation was assessed with laser flare meter instrument.ResultsIncision-making time (4.5 ± 0.9 min) and incision-closure time (2.8 ± 0.7 min) in the 23G group were significantly shorter than those in the 20G group (10.1 ± 1.5 min and 11.3 ± 2.2 min, respectively). No significant intergroup difference was observed with respect to time required for vitrectomy (21.6 ± 3.3 min and 20.7 ± 3.2 min, respectively). Ciliary body thickness in the 23G group recovered back to preoperative levels after 4 weeks, as against 8 weeks in the 20G group. Postoperative ciliary body thickness in the 20G group was significantly higher than that in the 23G group (p < 0.05). The aqueous protein concentration in 23G group recovered back to preoperative levels after 2 weeks, as against 4 weeks in the 20G group. Postoperative aqueous protein concentration in the 20G group was significantly higher than that in the 23G group (p < 0.05).ConclusionsThe use of 23G system was associated with significantly milder injury to the ciliary body as compared to that associated with the use of 20G system.Trial registrationThe study was retrospectively registered on Chinese Clinical Trial Registry. The clinical study registration number was ChiCTR-INR-17011082. Date of registration: 2017-04-07.

Trends in the characteristics of vitrectomy in Eastern China.

BackgroundSeveral new instruments and techniques for pars plana vitrectomy (PPV) have been widely used in recent years, but information about the related characteristics of PPV in China is limited. To investigate the trends in the characteristics of PPV in Eastern China, an 8-year retrospective study was conducted.Patients and methodsWe collected data from patients who underwent PPV at the Eye, Ear, Nose and Throat Hospital of Fudan University, Shanghai, China, in November 2007, November 2011, and November 2015. Cases of trauma-related retinopathy were excluded. Data on the patient demographics, surgical procedures, and the prophylactic use of IOP-lowering medications were collected and analyzed.ResultsIn 2015, most PPVs were conducted with a 23-gauge system, whereas all PPVs in 2007 and 2011 were conducted with a 20-gauge system. The proportions of macular disease in the population in 2007, 2011, and 2015 were 9.1%, 10.7%, and 21.5%, respectively (P<0.001). The proportion of PPV that was combined with lens extraction and intraocular lens (IOL) implantation increased significantly from 12.81% in 2007 to 25.95% by 2015 (P<0.001). The proportions of patients treated with IOP-lowering drugs in 2007, 2011, and 2015 were 27.40%, 38.20%, and 12.60%, respectively (P<0.001). In 2007, systemic carbonic anhydrase inhibitors (CAI-Ss) and beta blockers (BBs) were the two main types of prophylactic IOP-lowering drugs administered, but their use had decreased in 2015 (P<0.001). The preventive use of adrenergic agonists (AAs), topical carbonic anhydrase inhibitors (CAI-Ts), and prostaglandin analogs (PGAs) became increasingly frequent from 2007 to 2015 (P<0.05).ConclusionThe 23-gauge system, rather than the 20-gauge system, had become the mainstream PPV instrument by 2015. The proportion of macular disease patients requiring PPV in China clearly increased, and the rate of prophylactic IOP-lowering drug use decreased by 2015.

Sutureless 23-gauge Versus Sutureless 20-gauge Pars Plana Vitrectomy

Aim: To compare sutureless 23-gauge versus sutureless 20-gauge system for pars plana vitrectomy as regarding safety and efficacy in pars plana vitrectomy. Patients and methods: A prospective non –randomized interventional study comparing the two vitrectomy systems in a group of disease requiring uncomplicated vitreoretinal surgery was carried out at Nour- EL–Hayaha Eye Center (Cairo) between August, 2015 and June, 2017. Patients were divided into two groups. Group (A) 23 –gauge group: included thirty eyes of 20 patients, ten patients had bilateral pars plana vitrectomy (PPV), while in group (B): included twenty five eyes of 20patients, five patients had bilateral operations. Ocular examinations included measurements of best corrected visual acuity (BCVA) at a distance using a logarithm of the minimum angle of resolution (logMAR) scale, refractive status using an autorefractometer (KR-8100; Topcon corporation, Tokyo, Japan), IOP was measured pre and postoperative by Goldman applanation tonometry (CT-80; Topcon corporation, Tokyo, Japan), and fundus evaluation using an indirect ophthalmoscope were obtained. Surgical indication, outcome, intraoperative and postoperative complications were evaluated. Patients with vitreoretinal pathology such as preretinal membrane, vitreous haemorrhage with fibrovascular proliferation (FVP), persistent vitreous haemorrhage ,tractional retinal detachment, persistent macular edema or macular hole were enrolled in this study. Furthermore, postoperative subjective pain, conjunctival injection, retinal function and situation of retina were evaluated. Follow up was performed at the 1st day, 1st, 2nd week and 1st, 3rd and 6th month after surgery. Results: All the fifty five eyes completed the regularly follow up visits up to 24 months. 55 eyes of 40 patients divided into 2 groups: Group (A) 30 eyes of 20 patients (6 males, 30% and 14 females, 70%, the mean age of the participants ± SD was 54.62±3.12 years Range: 46-60 years;were treated with 23-gauge PPV .While in Group (B) twenty five eyes of 20 patients (13 males, 65% and 7 females, 35%, the mean age of the participants ± SD was 49.72±3.06 years Range: 50-58 years; were treated with sutureless 20-gauge PPV. The mean age of both groups ± SD was 52.67±5.14 years (Range: 47-62 years). Statistically, the differences between both groups regarding age and sex were insignificant. Conclusion: Advantages of sutureless vitrectomy include a reduction in operating time, less subconjunctival adhesion facilitating any subsequent vitreoretinal surgery or filtration surgery

Sutureless 23-gauge Versus Sutureless 20-gauge Pars Plana Vitrectomy

Aim: To compare sutureless 23-gauge versus sutureless 20-gauge system for pars plana vitrectomy as regarding safety and efficacy in pars plana vitrectomy. Patients and methods: A prospective non –randomized interventional study comparing the two vitrectomy systems in a group of disease requiring uncomplicated vitreoretinal surgery was carried out at Nour- EL–Hayaha Eye Center (Cairo) between August, 2015 and June, 2017. Patients were divided into two groups. Group (A) 23 –gauge group: included thirty eyes of 20 patients, ten patients had bilateral pars plana vitrectomy (PPV), while in group (B): included twenty five eyes of 20patients, five patients had bilateral operations. Ocular examinations included measurements of best corrected visual acuity (BCVA) at a distance using a logarithm of the minimum angle of resolution (logMAR) scale, refractive status using an autorefractometer (KR-8100; Topcon corporation, Tokyo, Japan), IOP was measured pre and postoperative by Goldman applanation tonometry (CT-80; Topcon corporation, Tokyo, Japan), and fundus evaluation using an indirect ophthalmoscope were obtained. Surgical indication, outcome, intraoperative and postoperative complications were evaluated. Patients with vitreoretinal pathology such as preretinal membrane, vitreous haemorrhage with fibrovascular proliferation (FVP), persistent vitreous haemorrhage ,tractional retinal detachment, persistent macular edema or macular hole were enrolled in this study. Furthermore, postoperative subjective pain, conjunctival injection, retinal function and situation of retina were evaluated. Follow up was performed at the 1st day, 1st, 2nd week and 1st, 3rd and 6th month after surgery. Results: All the fifty five eyes completed the regularly follow up visits up to 24 months. 55 eyes of 40 patients divided into 2 groups: Group (A) 30 eyes of 20 patients (6 males, 30% and 14 females, 70%, the mean age of the participants ± SD was 54.62±3.12 years Range: 46-60 years;were treated with 23-gauge PPV .While in Group (B) twenty five eyes of 20 patients (13 males, 65% and 7 females, 35%, the mean age of the participants ± SD was 49.72±3.06 years Range: 50-58 years; were treated with sutureless 20-gauge PPV. The mean age of both groups ± SD was 52.67±5.14 years (Range: 47-62 years). Statistically, the differences between both groups regarding age and sex were insignificant. Conclusion: Advantages of sutureless vitrectomy include a reduction in operating time, less subconjunctival adhesion facilitating any subsequent vitreoretinal surgery or filtration surgery

Valved 25-Gauge Cannula for Vitreous Tap and Injection.

To describe a technique that reduces patient discomfort by using a valved 25-gauge trocar for vitreous tap and intravitreal injection of medications in previously vitrectomized eyes with suspected infectious endophthalmitis. A commercially available 25-gauge valved entry system is used to enter the vitreous cavity. A 25-gauge needle attached to a syringe is used to obtain a vitreous specimen for microbiological access and administer intravitreal injections of antibiotics and steroids. No vitreous volume is lost during these procedures because of the cannula's valve. At the completion of the tap and injections, the cannula is removed with forceps and the single wound tamponaded with a cotton-tipped applicator. With this method, a vitreous tap and injection of pharmacologic agents only requires one piercing through the sclera, instead of the usual four piercings. With this new technique, it is possible to enhance patient comfort, decreased pain, and reduce trauma to the conjunctiva. [Ophthalmic Surg Lasers Imaging Retina. 2017;48:916-917.].

Twenty-nine-gauge dual-chandelier retroillumination for the non-open-sky continuous curvilinear capsulorhexis in the penetrating keratoplasty triple procedure

We describe a technique for the penetrating keratoplasty (PKP) triple procedure that uses 29-gauge dual-chandelier illumination during creation of a non-open-sky continuous curvilinear capsulorhexis (CCC). The chandeliers are inserted through the pars plana into the vitreous cavity through the bulbar conjunctiva at the 3 o'clock and 9 o'clock positions. We compared this approach with that of a core vitrectomy, in which a single 25-gauge port is inserted into the vitreous cavity transconjunctivally through the upper temporal pars plana. The area of halation around the corneal opacity was significantly smaller in the 29-gauge group than in the 25-gauge group. The reduction in halation improved visibility of the anterior capsule and enabled the surgeon to perform CCC with greater safety. The 29-gauge chandelier system was more suitable than the 25-gauge chandelier system for the non-open-sky CCC component of the PKP triple procedure.

Comparative study of 25- versus 20-gauge pars plana capsulotomy and vitrectomy in pediatric cataract surgery.

To compare 25- and 20-gauge pars plana vitrectomy (PPV) for the management of pediatric cataract. 20 eyes of 15 patients were randomly divided into two groups to undergo pars plana capsulotomy and vitrectomy by either 25-gauge (group A) or 20-gauge (group B) PPV after lens aspiration and IOL implantation. The two groups were compared for total surgical time, time taken in doing pars plana capsulotomy and vitrectomy, and the size of posterior capsulotomy. Post-operative astigmatism was compared at 3months. The mean total surgical time in group A was 49.2±6.7min, while mean total surgical time in group B was 62.5+5.48min (p=0.001). The mean time taken for pars plana capsulotomy and vitrectomy was 4.1±1.19min in group A and 5.0±0.73min (p=0.03) in group B. The mean size of the PCCC in group A was 3.3±0.34mm, while in group B it was 4.0±0.33mm (p=0.001). The mean astigmatism at 3months in group A was 0.65±0.31 diopters, while in group B it was 1.45±0.92 diopters (p=0.019). 25-gauge transconjunctival sutureless PPV can be an attractive alternative to 20-gauge system in the management of pediatric cataracts.

Comparison of the Operative Times and Intraocular Pressure of Sutureless Vitrectomy with a 27-versus 25-gauge System in Eyes with Epiretinal Membrane

Comparison of the Operative Times and Intraocular Pressure of Sutureless Vitrectomy with a 27-versus 25-gauge System in Eyes with Epiretinal Membrane

Fovea sparing internal limiting membrane peeling using multiple parafoveal curvilinear peels for myopic foveoschisis: technique and outcome.

BackgroundTo introduce a modified surgical technique, the “parafoveal multiple curvelinear internal limiting membrane (ILM) peeling”, to preserve epi-foveal ILM in myopic foveoschisis surgery.MethodsConsecutive patients with myopic foveoschisis were enrolled in the present prospective interventional case series. The surgeries were performed using transconjunctival 23-gauge system. The macular area was divided into quadrants. ILM was peeled off in a curvilinear manner centered around the site that was away from the central fovea in each quadrant. Shearing forces were used to control the direction to keep the peeling away from central fovea. ILM at central fovea of about 500 to 1000 μm was preserved by this technique.ResultsThis technique was performed in 20 eyes of 20 consecutive patients. Epi-foveal ILM was successfully preserved in all cases using the technique. Patients were followed up for more than 12 months. The mean postoperative logMAR visual acuity improved from 1.67 ± 0.65 preoperatively to 1.15 ± 0.49 (P = 0.015; paired t-test). Postoperative OCT examinations showed that full-thickness macular holes (MHs) did not developed in any case. Central fovea thickness decreased from 910 ± 261 μm preoperatively to 125 ± 85 postoperatively (P = 0.001; paired t-test).ConclusionFovea sparing ILM peeling using multiple parafoveal curvilinear peels prevents the development of postoperative full-thickness MHs in eyes with myopic foveoschisis.Electronic supplementary materialThe online version of this article (doi:10.1186/s12886-016-0356-4) contains supplementary material, which is available to authorized users.

INTRAOCULAR PRESSURE CHANGES DURING VITRECTOMY USING CONSTELLATION VISION SYSTEM'S INTRAOCULAR PRESSURE CONTROL FEATURE.

To evaluate intraocular pressure (IOP) changes during experimental vitrectomy and the efficacy of Constellation Vision System's IOP control (IOPc) feature in reestablishing baseline pressure. Using a pressure transducer in freshly enucleated porcine eyes, a broad range of parameters (baseline pressures, aspiration levels, and cut rates) were tested with 23- and 25-gauge probes and IOPc turned ON versus OFF. IOPc turned ON was significantly more effective than IOPc turned OFF in controlling IOP drop and stabilizing pressure during vitrectomy using a wide range of baseline pressures (20-70 mmHg). The 23-gauge system consistently presented a reduced drop from baseline compared with the 25-gauge system. The overall average drop for the 23- and 25-gauge systems was 12.79 mmHg and 21.17 mmHg, respectively. Both gauge sizes reestablished baseline pressure approximately 1.6 seconds after the initial pressure drop generated at the beginning of aspiration. A peak of IOP (overshooting) was observed when the pressure was returning to baseline using both 23- and 25-gauge systems. Using IOPc feature turned ON, 23- and 25-gauge probes were effective in reestablishing and sustaining baseline infusion pressures, although 23-gauge probes showed less IOP fluctuation than did 25-gauge probes.

A simple modification to the 25-gauge trocar and cannula system for retinopathy of prematurity related lens-sparing vitrectomy.

BackgroundRecently, 25-gauge vitrectomy has become more popular. However, most still perform the surgery in pediatric patients without the use of the trocars and cannulas as in adult vitrectomies.MethodsWe described a simple modification using adult 25-gauge cannulas and 270-silicone watzke sleeves, enabling these instruments to be used in pediatric cases. The sleeve is cut into segments of 2 mm in length, and then introduced up the shaft of the 25-gauge trocar. One is introduced first, and a second one is introduced on top of the first one. This secures the two sleeves on the shaft of the trocar, such that they act as a spacer. The effective shaft of the trocar was then reduced to 2 mm in length.ResultsThis method enabled successful surgery in two cases.ConclusionsThis allows the adaptation of the standard 25-gauge system for pediatric cases with only the slightest modification needed.Electronic supplementary materialThe online version of this article (doi:10.1186/s12886-016-0214-4) contains supplementary material, which is available to authorized users.

Active Silicone Oil Removal with a Transconjunctival Sutureless System: Is the 23-Gauge System Safe and Effective?

Objectives:To evaluate the safety and efficacy of active silicone oil removal with a 23-gauge (G) transconjunctival sutureless system.Materials and Methods:One hundred sixteen eyes of 113 patients who had previous retinal detachment surgery with pars plana vitrectomy and silicone oil injection surgery, and underwent silicone oil removal surgery with 23-G transconjonctival sutureless technique in our clinic between January 2009 and April 2014 were reviewed retrospectively. The patients were evaluated with regard to postoperative changes in best corrected visual acuity and intraocular pressure (IOP), and complications that occurred during and after surgery.Results:Of the 113 patients with mean age of 61.1±9.7 years (29-88 years), 62 (54.8%) were males and 51 (45.2%) were females. Silicone oil removal was performed 8.43±5.24 months after the initial surgery. Mean follow-up was 13.38±4.35 months. Visual acuity improved in 69 eyes (59.48%). Anatomic success was achieved in 113 eyes (97.41%). Mean IOP was 16.2±7.2 mmHg at baseline and 14.4±2.6 mmHg at postoperative day 1 (p=0.643). Eight eyes needed suturation of at least one sclerotomy. Retinal redetachment occurred in 3 eyes (2.5%) resulting in a decrease in vision. There were no cases of choroidal detachment, endophthalmitis, clinically significant corneal endothelial decompensation, or macular edema.Conclusion:Active removal of 1,300-centistoke silicone oil with a 23-G transconjunctival sutureless system is a simple, sutureless technique causing minor surgical trauma. Active removal of silicone oil with the 23-G transconjunctival sutureless technique was found to be effective and safe in both phakic and pseudophakic eyes.