Small gauge vitrectomy: Recent update

Khanduja, Sumeet; Kakkar, Ashish Kumar; Majumdar, Saptrishi; Vohra, Rajpal; Garg, Satpal

doi:10.4103/0974-620x.111893

Cited by 26 publications

(23 citation statements)

References 53 publications

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“…The development of small-gauge (23-G and 25-G) vitrectomy, or minimally invasive vitreous surgery, without compromising outcomes is one of the most important goals of surgeons. 13 With this aim, Fujii et al 6 began to use the 25-G transconjunctival sutureless vitrectomy technique in the surgical treatment of uncomplicated vitreoretinal patients. In later years, Eckardt 7 introduced the 23-G transconjunctival sutureless vitrectomy technique.…”

Section: Discussionmentioning

confidence: 99%

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

Kaya¹,

Özyurt²,

Öztürk³

et al. 2016

tjo

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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.

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Section: Discussionmentioning

confidence: 99%

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

Kaya¹,

Özyurt²,

Öztürk³

et al. 2016

tjo

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“…It has a well-known risk profile and, justifiably, there is reluctance to perform this surgery to treat floaters [ 2 ]. However, technological advances in both instrumentation and techniques have made PPV a much safer procedure [ 20 , 21 ]. Small-gauge vitrectomy offers the advantages of minimal invasiveness, reduced postoperative inflammation and complications, and faster recovery [ 21 ].…”

Section: Discussionmentioning

confidence: 99%

Small-Gauge Pars Plana Vitrectomy for the Management of Symptomatic Posterior Vitreous Detachment after Phacoemulsification and Multifocal Intraocular Lens Implantation: A Pilot Study from the Pan-American Collaborative Retina Study Group

Navarro¹,

Machado

Maia³

et al. 2015

Journal of Ophthalmology

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Purpose. To determine the efficacy of 23-gauge pars plana vitrectomy (PPV) for symptomatic posterior vitreous detachment (PVD) on visual acuity (VA) and quality after multifocal intraocular lenses (IOLs). Methods. In this prospective case series, patients who developed symptomatic PVD and were not satisfied with visual quality due to floaters and halos after multifocal IOL implantation underwent PPV. Examinations included LogMAR uncorrected visual acuity (UCVA), intraocular pressure, biomicroscopy, and indirect ophthalmoscopy at baseline and 1, 7, 30, and 180 days postoperatively. Ultrasonography and aberrometry were performed. The Visual Functioning Questionnaire 25 (VFQ-25) was administered preoperatively and at 30 days postoperatively. Both the postoperative UCVA and questionnaire results were compared to preoperative findings using the Wilcoxon test. Results. Sixteen eyes of 8 patients were included. VA significantly improved from 0.17 to 0.09 postoperatively (P = 0.017). All patients reported improvement of halos, glare, and floaters. VFQ-25 scores significantly improved in general vision (P = 0.023), near activities (P = 0.043), distance activities (P = 0.041), mental health (P = 0.011), role difficulties (P = 0.042), and driving (P = 0.016). Conclusion. PPV may increase UCVA and quality of vision in patients with bilateral multifocal IOLs and symptomatic PVD. Larger studies are advised.

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“…11,12 The 20-gauge (20G) standard of the 1980s and 1990s has gotten progressively smaller and is now routinely available as 27G mostly due to technical improvements such as the introduction of pneumatically driven single-use continuous flow dual blade cutters and the use of disposable instruments with material properties that allow precise control of shear forces. 13 In addition to these technological cornerstones, a further improvement came through the introduction of trocar systems that reduce the risk of entry site breaks. 1,14 An increased cutting speed as well as minimized tractional forces to the vitreal base and retinal periphery reduce the risk of postoperative retinal detachment despite shorter surgical times.…”

Section: Introductionmentioning

confidence: 99%

“…2,3 As smaller sclerotomy size leads to lower surgical trauma to the ocular surface, 15 efforts are underway to further reduce the size beyond 27G. 13,[16][17][18] Despite having theoretical advantages, 18 27G vitrectomy has not generally been accepted as the new MIVS standard. This may be related to technical challenges resulting from the small opening of the cutter, namely detaching a strongly adherent vitreous, particularly in younger individuals, and cutting back the vitreal base.…”

Section: Introductionmentioning

confidence: 99%

<p>Hybrid 23/27 Gauge Vitrectomy – Combining the Charm of 27G with the Efficacy of 23G</p>

Garweg

Ouassi

Pfister

2020

OPTH

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Background: Minimally invasive transconjunctival sutureless vitrectomy (MIVS) has evolved into the standard of care, smaller incisions thought to result in lower ocular surface trauma and shorter times to recovery. The currently most relevant limitations in macular surgery may be light intensity and 27G instrument stability. Therefore, we thought to compare standard 23 and 27G vitrectomy with a hybrid technique using one 23G and two 27G ports regarding surgical times and short-term outcomes. Methods: This retrospective comparison included 90 single-center consecutive cases of eyes undergoing elective micro-invasive vitrectomy for epiretinal membranes or idiopathic macular holes between October 2017 and June 2018. The main criteria for the comparison were total surgical time as primary outcome parameter and treatment-demanding intra-and postoperative complications along with recovery of best-corrected visual acuity (BCVA) and central retinal thickness (CRT) from prior to surgery to 1 month thereafter as secondary parameters as independent parameters for the recovery from the pre-existing pathology and the surgical trauma. Results: Surgical times were shorter with 23G and 23/27G compared to 27G (23G: 38.4 ±13.1; 27G: 48.1±15.3; 23/27G: 34.9±9 mins; p=0.0005) with no differences in BCVA and CRT outcomes. Switching from 27G to a larger port size was not necessary in any instance. Cryotherapy was applied in 15%, 30%, and 22.5% to suspected retinal pathologies, beyond these, in 5%, 0%, and 7.5% for retinal tears. Four postoperative retinal detachments occurred (4.4%), one in the 23G and three in the 23/27G group requiring re-vitrectomy. Conclusion: In this exploratory case series, 23/27G hybrid vitrectomy, combining the advantages of 23G and 27G techniques, resulted in shorter surgical times without evident disadvantages. The combination with cataract surgery was unproblematic.

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Small gauge vitrectomy: Recent update

Cited by 26 publications

References 53 publications

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

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

Small-Gauge Pars Plana Vitrectomy for the Management of Symptomatic Posterior Vitreous Detachment after Phacoemulsification and Multifocal Intraocular Lens Implantation: A Pilot Study from the Pan-American Collaborative Retina Study Group

<p>Hybrid 23/27 Gauge Vitrectomy – Combining the Charm of 27G with the Efficacy of 23G</p>

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