Advantages and Limitations of Small Gauge Vitrectomy

Thompson, John T.

doi:10.1016/j.survophthal.2010.08.003

Cited by 132 publications

(138 citation statements)

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“…Position and angle of infusion cannula during vitrectomy is known to be an important factor in intraoperative complications such as serous retinal detachment and choroidal haemorrhage [1,2]. More specifically during macular hole surgery there is evidence that FAX can be associated with visual field defects corresponding with the position and direction of this cannula [3][4][5].…”

Section: Commentmentioning

confidence: 99%

Macular Hole Eruption after Pars Plana Vitrectomy

Rainsbury¹,

Gosse²,

Lochhead³

2015

J Clin Exp Ophthalmol

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Macular hole eruption is a previously unreported complication of vitrectomy for full thickness macular hole (FTMH) repair. Keywords Macular hole; Plana vitrectomy; FTMH repair Case ReportAn 83 year old male presented with a full thickness macular hole. The visual acuity was 6/24 in the right eye, measured using a standard 6 m Snellen chart. A standard 25-Gauge 3-port (non-valved) pars plana vitrectomy, internal limiting membrane (ILM) peel and gas tamponade was performed on the right eye ( Figure 1A). The procedure was performed using the Alcon Constellation system, with the infusion pressure set at 25-35 mmHg throughout the procedure. This machine incorporates an automated IOP stabilisation system, which significantly reduces fluctuations in intraocular pressure perioperatively. After vitrectomy the ILM was stained with Dual Blue dye (under fluid). Peeling of the ILM was then commenced, without any adjustment of the IOP setting of the vitrectomy machine. During the peel stage, irrigation fluid surged from the infusion port following removal of the ILM forceps, resulting in a jet of fluid directly entering the macular hole, causing it to visibly erupt. On re-inserting the forceps the flow of fluid through the eye was stabilised.The FTMH was noted to have torn inferiorly and superiorly and a small area of localised retinal detachment was noted around the hole (Figure 2A and B). The ILM peeling was then carefully completed with removal of approximately 2 disc diameters of ILM from around the centre of the macular hole (see supplementary online video), followed by routine fluid/air/gas (C3F8 18%) exchange. No additional procedures were required for the localised retinal detachment which flattened with the intraocular gas tamponade. Postoperatively the FTMH closed ( Figure 1B) and the patient achieved 6/24 vision. Rainsbury PG et al., J Clin Exp Ophthalmol 2015, 6:1 http://dx Clinical & Experimental Ophthalmology

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Section: Commentmentioning

confidence: 99%

Macular Hole Eruption after Pars Plana Vitrectomy

Rainsbury¹,

Gosse²,

Lochhead³

2015

J Clin Exp Ophthalmol

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“…The use of small gauge instruments has various effects on the vitrectomy technique: the modification of fluidics during surgery, the decrease of illumination, the need of fewer accessory instruments and the availability of fewer multi-function instruments [1,2,7].…”

Section: Technical Considerations On Mivsmentioning

confidence: 99%

“…Although MIVS is increasingly popular, its use varies substantially according to the personal experience of each vitreo-retinal surgeon. Some surgeons use MIVS in all the vitrectomy cases, whereas others choose it only in selected circumstances and others don't use it at all [2,3].…”

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confidence: 99%

Innovative Technologies in Pars Plana Vitrectomy - Minimally Invasive Vitrectomy System

Ţălu¹

2013

LSMR

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Abstract-Minimally Invasive Vitrectomy System is a concept that was developed during the past years with the goal to make pars plana vitrectomy a safer and a less traumatizing procedure. The development of small gauge vitrectomy systems has led to the decrease of tissue damage and the shortening of the operating time. Although MIVS is increasingly popular, its use varies substantially according to the personal experience of each vitreo-retinal surgeon. The transition from the 20 gauge to the small gauge vitrectomy (23G, 25G) is directly related to the global approach to vitrectomy regarding incision making, intraoperative fluidics, cutting technology, illumination and accessory instruments. The development of new instruments capable to overcome the size and lumen handicaps became necessary. The use of small gauge instruments has various consequences on the vitrectomy itself: the modification of fluidics during surgery, the decrease of illumination, the need of fewer accessory and multi-function instruments.For the past 12 months, we used 25+ vitrectomy system sustained by the Constellation platform, in 296 cases that required vitreo-retinal surgery. The clinical conditions were the following ones: rhegmatogenous retinal detachments (120 cases -40.54%), vitreous haemorrhages (100 cases -33.78%), tractional retinal detachments (35 cases -11.82%), epimacular membranes (15 cases -5.06%), nucleus/lens luxated into the vitreous cavity (11 cases -3.71%), intraocular foreign bodies (6 cases -2.02%), macular holes (5 cases -1.68%), endophthalmitis (4 cases -1.35%).In this paper, the personal experience of using MIVS in variate cases that required vitreo-retinal surgery is illustrated.

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“…This technique can also be utilized to decrease surgical time when instilling or removing 5,000 centistoke silicone oil. Currently, small gauge pars plana lensectomy is only effecfive on soft cataracts, while dense cataracts require at least one 20-gauge port, although 23-gauge phacofragmenters are currently being developed (Thompson, 2011 Table 1. Indications for small gauge vitrectomy in adult and pediatric eyes.…”

Section: Indicationsmentioning

confidence: 99%