“…The decreased vitreous flow rate or so-called “cutting efficiency” observed with those smaller 27-gauge instruments was at least partially overcome by the development of higher cutting speed devices and high aspiration levels along with duty cycle improvements (described in next sections) that are already present on some of the commercially available platforms [7, 14, 19, 20]. In a recent publication, the mean operative time was similar to the initial reports using the 23-gauge instruments, regardless the potentially reduced flow rate [12]. Fig.…”
Section: Vitrectomy Cuttersmentioning
confidence: 53%
“…Subsequent years have shown that the modern MIVS have numerous advantages over 20-gauge vitrectomy and are associated with better patient comfort, less conjunctival scarring, less postoperative inflammation and earlier visual recovery [7–11]. More recently, 27-gauge instruments released by different companies have shown encouraging results [7–9, 12, 13]. …”
Section: Vitrectomy Cuttersmentioning
confidence: 99%
“…More complex cases including diabetic retinopathy, rhegmatogenous retinal detachment and nucleus fragments removal have been managed with the next generation of 27-gauge cutter probes [7, 9, 12–14, 18]. The thinner instrument can be safely introduced into smaller spaces between membranes and retina, serving as a multifunctional device and facilitating tissue dissection [7, 14, 18].…”
Section: Vitrectomy Cuttersmentioning
confidence: 99%
“…The smaller vitrectomy diameter and the port aperture closer to the tip can be positioned between narrow spaces, allowing membrane dissection and serving as a multifunctional instrument. The concerns about lack of endoillumination (see next section) have been resolved by the introduction of powerful Xenon, LED and future laser light sources [7, 8, 12, 13, 18, 49]. …”
There have been many advances in vitreoretinal surgery since Machemer introduced the concept of pars plana vitrectomy, in 1971. Of particular interest are the changes in the vitrectomy cutters, their fluidics interaction, the wide-angle viewing systems and the evolution of endoillumination through the past decade and notably in the last few years. The indications of 27-gauge surgery have expanded, including more complex cases. Cut rates of up to 16,000 cuts per minute are already available. New probe designs and pump technology have allowed duty cycle performances of near 100% and improved flow control. The smaller vitrectomy diameter can be positioned between narrow spaces, allowing membrane dissection and serving as a multifunctional instrument. Enhanced endoillumination safety can be achieved by changing the light source, adding light filters, increasing the working distance and understanding the potential interactions between light and vital dyes commonly used to stain the retina. Wide-angle viewing systems (contact, non-contact or a combination of both) provide a panoramic view of the retina. Non-contact systems are assistant-independent, while contact systems may be associated with better image resolution. This review will cover some current aspects on vitrectomy procedures, mainly assessing vitrectomy cutters, as well as the importance of endoillumination and the use of wide-angle viewing systems.Electronic supplementary materialThe online version of this article (doi:10.1186/s40942-016-0052-9) contains supplementary material, which is available to authorized users.
“…The decreased vitreous flow rate or so-called “cutting efficiency” observed with those smaller 27-gauge instruments was at least partially overcome by the development of higher cutting speed devices and high aspiration levels along with duty cycle improvements (described in next sections) that are already present on some of the commercially available platforms [7, 14, 19, 20]. In a recent publication, the mean operative time was similar to the initial reports using the 23-gauge instruments, regardless the potentially reduced flow rate [12]. Fig.…”
Section: Vitrectomy Cuttersmentioning
confidence: 53%
“…Subsequent years have shown that the modern MIVS have numerous advantages over 20-gauge vitrectomy and are associated with better patient comfort, less conjunctival scarring, less postoperative inflammation and earlier visual recovery [7–11]. More recently, 27-gauge instruments released by different companies have shown encouraging results [7–9, 12, 13]. …”
Section: Vitrectomy Cuttersmentioning
confidence: 99%
“…More complex cases including diabetic retinopathy, rhegmatogenous retinal detachment and nucleus fragments removal have been managed with the next generation of 27-gauge cutter probes [7, 9, 12–14, 18]. The thinner instrument can be safely introduced into smaller spaces between membranes and retina, serving as a multifunctional device and facilitating tissue dissection [7, 14, 18].…”
Section: Vitrectomy Cuttersmentioning
confidence: 99%
“…The smaller vitrectomy diameter and the port aperture closer to the tip can be positioned between narrow spaces, allowing membrane dissection and serving as a multifunctional instrument. The concerns about lack of endoillumination (see next section) have been resolved by the introduction of powerful Xenon, LED and future laser light sources [7, 8, 12, 13, 18, 49]. …”
There have been many advances in vitreoretinal surgery since Machemer introduced the concept of pars plana vitrectomy, in 1971. Of particular interest are the changes in the vitrectomy cutters, their fluidics interaction, the wide-angle viewing systems and the evolution of endoillumination through the past decade and notably in the last few years. The indications of 27-gauge surgery have expanded, including more complex cases. Cut rates of up to 16,000 cuts per minute are already available. New probe designs and pump technology have allowed duty cycle performances of near 100% and improved flow control. The smaller vitrectomy diameter can be positioned between narrow spaces, allowing membrane dissection and serving as a multifunctional instrument. Enhanced endoillumination safety can be achieved by changing the light source, adding light filters, increasing the working distance and understanding the potential interactions between light and vital dyes commonly used to stain the retina. Wide-angle viewing systems (contact, non-contact or a combination of both) provide a panoramic view of the retina. Non-contact systems are assistant-independent, while contact systems may be associated with better image resolution. This review will cover some current aspects on vitrectomy procedures, mainly assessing vitrectomy cutters, as well as the importance of endoillumination and the use of wide-angle viewing systems.Electronic supplementary materialThe online version of this article (doi:10.1186/s40942-016-0052-9) contains supplementary material, which is available to authorized users.
“…One-step trocar insertion perpendicular to the pars plana is preferred to angled insertion leading to less instrumentation bending. This wound construction approach also results in a low rate of complications; no cas- es of postoperative hypotony and few cases of sclerotomy suturing have been reported [1,2]. Trocars are inserted closer to the 9 and 3 o'clock positions, allowing better access to the 12 o'clock peripheral vitreous.…”
Purpose: We present the advantages and technique variations of 27-G vitrectomy in a variety of surgical retina cases. Methods: Patients with epiretinal membrane, retinal detachment, and proliferative diabetic retinopathy with vitreous hemorrhage and tractional detachments underwent 27-G vitrectomy. We present technique tricks, solutions to various problems and pitfalls, and the advantages of 27-G vitrectomy. Results: Postoperative visual acuity improved significantly in all patients. Anatomical restoration was achieved in all cases. Conclusions: 27-G vitrectomy offers satisfactory outcomes in a wide variety of surgical retina cases and shows significant advantages in the postoperative course.
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