Difficulty in Inserting 25- and 23-Gauge Trocar Cannula during Vitrectomy

Abstract

Purpose: To determine the incidence of difficulty in inserting a 25- and 23-gauge trocar cannula (DITC) during 25- or 23-gauge micro-incision vitrectomy surgery (MIVS). Methods: Retrospective, consecutive, interventional case series performed by a single surgeon at a single centre. We defined a DITC as the condition where at least 1 trocar cannula could not be inserted into the vitreous at the beginning of MIVS. The incidence of DITC was calculated from 1,525 eyes, and the pre-operative demographics of the DITC cases were compared to those of the non-DITC cases. Results: The incidence of DITC for all cases was 0.6% (9 of 1,525 eyes). Overall, there were 242 eyes with a retinal detachment (RD), and 8 of the 9 eyes with DITC had an RD with an incidence of 3.3% (8 of 242 RD eyes). Seven of these 8 eyes had a total RD, 4 also had a choroidal detachment, 4 eyes were also myopic (>–8.0 dpt, high myopia), and 6 of the 8 eyes were hypotonic (<8 mm Hg). The DITC cases had larger RDs (p < 0.0001), a higher incidence of choroidal detachment (p < 0.0001), higher myopia (p = 0.0204) and hypotony (p = 0.0003) than the non-DITC eyes with an RD. Conclusions: A large RD, a choroidal detachment, high myopia and hypotony are significant risk factors for DITC. We recommend that MIVS should be performed cautiously for eyes with these risk factors.

Efficacy of combined 25-gauge microincision vitrectomy, intraocular lens implantation, and posterior capsulotomy

“…15 Some patients (%1.0%) should have microincision vitrectomy surgery with caution. 16 However, the indication for 25-gauge microincision vitrectomy has expanded to various diseases, including PDR, RRD, giant retinal tear detachment, intraocular foreign body, and IOL dislocation, 17-25 because of the Table 2). Lower: A 60-year-old man with RRD (eye 20, Table 2).…”

25-Gauge Microincision Vitrectomy to Treat Vitreoretinal Disease in Glaucomatous Eyes after Trabeculectomy

“…Furthermore, 25GMIVS allows earlier postoperative visual improvement than 20GPPV and does not induce significant changes in the corneal topography or optical quality of the cornea [16–20]. Although 25GMIVS does have limitations [21–23], we believe that because it is sutureless, it is the best choice to treat retinal disease in eyes with preexisting TLE and can best preserve the filtering bleb. However, to the best of our knowledge, using the PubMed search system, there are no reports discussing or evaluating the use of 25GMIVS to treat retinal diseases in glaucomatous eyes after TLE, except one case report of familial amyloid polyneuropathy (FAP) [24].…”

A novel three-dimensional printed device to improve the safety of trocar insertion in hypotonous eyes

“…A retrospective study reviewing difficulties in trocar insertion showed that it was not possible to safely insert at least one 23- or 25-gauge trocar cannula into a quarter of eyes with a preoperative intraocular pressure of less than 8 mmHg. [ 3 ] Instead, vitrector-assisted sclerotomy had to be performed. Other articles discuss complications such as inadvertent posterior capsule rupture due to the amount of deformity caused by trocar insertion into a hypotonous eye.…”