Tips, Tricks, and Advantages of 27-G Vitrectomy

Anastasilakis, Konstantinos; Mourgela, Anna; Kaniouras, Dhmos; Moschou, Konstantinos

doi:10.1159/000485519

Cited by 6 publications

(6 citation statements)

References 7 publications

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“…Our anatomic success rate of 93% is similar to previously reported results [ 2 ]. In addition, we observed a low rate of complications for other vitrectomy indications, in keeping with prior reports [ 25 ]. The macular hole closure rate observed in the present study is consistent with previous reports [ 26 ].…”

Section: Discussionsupporting

confidence: 91%

Twenty-seven-gauge vitrectomy: a consecutive, single-centre case series with exclusive use over a 4-year period

Ng,

Masalkhi,

Steel

et al. 2023

BMC Ophthalmol

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Background To assess the safety and effectiveness of the exclusive use of 27-gauge instruments for all vitreoretinal diseases requiring vitrectomy. Methods In this retrospective study, 1020 consecutive surgeries were performed on 958 eyes of 848 patients using 27-gauge instruments from March 2017 to June 2021. Patients with a minimum follow-up of 3 months were included. Surgical case-mix, best-corrected visual acuity (BCVA), intraocular pressure (IOP), intra- and post-operative complications, and surgery times were recorded. Results The study patients were followed up for averagely 11 months. Of the 1020 vitrectomies, 958 were primary procedures. Of the 148 retinal detachment (RD) cases, 138 (93%) required a single vitrectomy. Primary macular hole closure was achieved in 143 of 145 (99%) cases. The average surgical times were 55 and 38 min for RD surgeries and for all other indications, respectively. BCVA improved significantly at the final visit (20/49) compared with the pre-operative visit (20/78) (p < 0.01). IOP was similar at the pre-operative (14.8mmHg) and final (14.3mmHg) visits. Complications recorded include transient hypotony in 39 eyes, iatrogenic retinal breaks in 2 eyes, and a vitreous bleed in 1 other eye. Conclusion This study revealed that 27-gauge vitrectomy instruments can be used for a wide range of indications, with exclusive use in certain settings. The outcomes were similar to other gauges, including for rhegmatogenous retinal detachment, with minimal complications.

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Section: Discussionsupporting

confidence: 91%

Twenty-seven-gauge vitrectomy: a consecutive, single-centre case series with exclusive use over a 4-year period

Ng,

Masalkhi,

Steel

et al. 2023

BMC Ophthalmol

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“…Our main modifications were introducing self-sealing scleral flaps, reducing the 23 G sclerotomies to 27 G (externalizing the anchors) and moving the sclerotomy sites slightly from the 3 and 9 o'clock position to the 2 and 8 o' clock 15 Enghelberg, and Chalam. 16 Reducing the sclerotomies to 27 G that are used to externalize the haptics should not only increase the hold ability but also prevent postoperative hypotony in a sutureless approach as was shown for 27 G vitrectomy both by Anastasilakis et al 17 and Naruse et al 18 It is noteworthy that we recently had to explant one Carlevale IOL. In cases where an explantation of the IOL is necessary, the anchors can simply be pulled back using a forceps and the IOL can be folded and explanted by a tunnel incision of 2.4 mm.…”

Section: Discussionmentioning

confidence: 90%

“…Reducing the sclerotomies to 27 G that are used to externalize the haptics should not only increase the hold ability but also prevent postoperative hypotony in a sutureless approach as was shown for 27 G vitrectomy both by Anastasilakis et al 17 and Naruse et al 18 It is noteworthy that we recently had to explant one Carlevale IOL. In cases where an explantation of the IOL is necessary, the anchors can simply be pulled back using a forceps and the IOL can be folded and explanted by a tunnel incision of 2.4 mm.…”

Section: Discussionmentioning

confidence: 92%

Modified Sutureless Intrascleral Fixation Technique for Secondary Intraocular Lens Implantation

Januschowski

Boden

Macek

et al. 2023

Retina

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Background/Purpose: To demonstrate possible complications of a new intraocular lens for sutureless secondary scleral implantation and modifications of the surgical technique to optimize outcomes. Methods: A retrospective study of 16 eyes (16 patients) who underwent a secondary intraocular lens implantation using the Carlevale intraocular lens (Soleko, Italy) with two anchor haptics for intrascleral implantation (mean follow-up 2.2 months). Results: The visual acuity did not improve statistically significantly postoperatively (P = 0.601). Seven (44%) patients suffered from postoperative hypotonia (intraocular pressure <5 mmHg) during the first three postoperative days. Conclusion: Owing to the early postoperative hypotony, we decided to modify the surgical technique. We present several suggestions to optimize the technique and outcome such as positioning the sclerotomies at the 2 and 8 o'clock positions, using 27 G trocars alone and suturing the frown incisions using self-resorbing sutures.

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“…Regarding MIVS for PDR treatment, most people believe that a smaller VP can more easily enter the gap below the proliferative membrane to achieve an accurate operation. However, some studies have shown that the traditional 27G vitrectomy system does not have many advantages over other systems [ 14 – 17 ]. The vitrectomy technique for PDR patients still needs further development.…”

Section: Discussionmentioning

confidence: 99%

Comparison of 27-gauge beveled-tip and 25-gauge flat-tip microincision vitrectomy surgery in the treatment of proliferative diabetic retinopathy: a randomized controlled trial

Liu,

Liu

et al. 2023

BMC Ophthalmol

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Purpose To compare the effectiveness and safety of a 27-gauge (27G) beveled-tip microincision vitrectomy surgery (MIVS) with a 25-gauge (25G) flat-tip MIVS for the treatment of proliferative diabetic retinopathy (PDR). Methods A prospective, single-masked, randomized, controlled clinical trial included 52 eyes (52 patients) with PDR requiring proliferative membrane removal. They were randomly assigned in a 1:1 ratio to undergo the 27G beveled-tip and or 25G flat-tip MIVS (the 27G group and the 25G group, respectively). During surgery, the productivity of cutting the membrane, the number of vitrectomy probe (VP) exchanges to microforceps, total operation time, vitrectomy time and intraoperative complications were measured. Best-corrected visual acuity (BCVA), intraocular pressure (IOP) and postoperative complications were also assessed to month 6. Results Forty-seven eyes (47 patients) completed the follow-up, including 25 in the 27G group and 22 in the 25G group. During surgery in the 27G group, cutting the membrane was more efficient (P = 0.001), and the number of VP exchanges to microforceps was lower (P = 0.026). The occurrences of intraoperative hemorrhages and electrocoagulation also decreased significantly (P = 0.004 and P = 0.022). There were no statistical differences in the total operation time or vitrectomy time between the two groups (P = 0.275 and P = 0.372), but the former was slightly lower in the 27G group. Additionally, the 27G group required fewer wound sutures (P = 0.044). All the follow-up results revealed no significant difference between the two groups. Conclusions Compared with the 25G flat-tip MIVS, the 27G beveled-tip MIVS could be more efficient in removing the proliferative membrane while reducing the occurrence of intraoperative hemorrhages and electrocoagulation using appropriate surgical techniques and instrument parameters. Its vitreous removal performance was not inferior to that of the 25G MIVS and might offer potential advantages in total operation time. In terms of patient outcomes, advanced MIVS demonstrates equal effectiveness and safety to 25G flat-tip MIVS. Trial registration The clinical trial has been registered at Clinicaltrials.gov (NCT0544694) on 07/07/2022. And all patients in the article were enrolled after registration.

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Tips, Tricks, and Advantages of 27-G Vitrectomy

Cited by 6 publications

References 7 publications

Twenty-seven-gauge vitrectomy: a consecutive, single-centre case series with exclusive use over a 4-year period

Twenty-seven-gauge vitrectomy: a consecutive, single-centre case series with exclusive use over a 4-year period

Modified Sutureless Intrascleral Fixation Technique for Secondary Intraocular Lens Implantation

Comparison of 27-gauge beveled-tip and 25-gauge flat-tip microincision vitrectomy surgery in the treatment of proliferative diabetic retinopathy: a randomized controlled trial

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