Longer-term outcomes of transconjunctival sutureless 25-gauge vitrectomy

PURPOSE: To report longer-term outcomes in eyes undergoing 25-gauge transconjunctival sutureless vitrectomy. DESIGN: Retrospective, noncomparative, case series. METHODS: Chart review of the initial 45 consecutive patients (45 eyes) that underwent TSV by one surgeon (T.S.H.) for idiopathic epiretinal membrane (n = 15), refractory diabetic macular edema (n = 11), idiopathic macular hole (n = 10), and nonclearing vitreous hemorrhage (n = 9). All patients had at least 6-month follow-up. Main outcome measures included visual acuity (VA), intraocular pressure, intraoperative complications, and postoperative complications. RESULTS: Mean follow-up was 13 months (range 6 to 25 months). Mean overall preoperative VA vs last postoperative VA was 20/229 and 20/65, respectively (P < .0001). Statistically significant VA improvement was seen for each patient subgroup. Mean preoperative intraocular pressure was 16.9 mm Hg (range 10-26 mm Hg). On postoperative day 1, week 1, and week 4, median intraocular pressure was 14.6 mm Hg (range 8-17 mm Hg), 17.6 mm Hg (range 8-38 mm Hg), and 17.7 mm Hg (range 9-33 mm Hg), respectively. No intraoperative complications occurred. Postoperative complications were 1 inferior retinal detachment (2.2%) 4 weeks after macular hole repair, 1 macular hole (2.2%) 6 months after epiretinal membrane peel, and 23 worsening cataracts in 29 phakic eyes (79.3%). CONCLUSIONS: Less surgically complex vitreoretinal pathology may be successfully repaired with TSV. After a mean follow-up of more than 1 year, minimal complications were seen, and none was specifically related to the sutureless nature of the procedure.     

Gentamicin-induced macular infarction in transconjunctival sutureless 25-gauge vitrectomy

Purpose State Gentamicin antibiotic prophylaxis is contraindicated in 25 gauge Transconjunctival Sutureless Vitrectomy. Methods A 75-year-old diabetic woman was affected by glaucoma and mild diabetic retinopathy in both eyes, and epiretinal membrane in the left eye. A 25-gauge Transconjunctival Sutureless Vitrectomy (TSV) was performed with self-sealing transconjunctival scletomies of the left eye. Post-operation antibiotic prophylaxis was obtained by subconconjunctival injection of Gentamicin sulfate (0.4 mg/ml) adjacent to scletomies. Results A month after the operation visual acuity had not recovered. Fluorescein angiography detected occlusion of perifoveal capillaries. Conclusion Antibiotics, in particular gentamicin, have the potential to cause significant ocular toxicity when they gain access to the inside of the eye, through thinned sclera or sutureless sclerotomies of TSV.     

25G经结膜穿刺法玻璃体切割术治疗特发性黄斑裂孔

目的:探讨小切口玻璃体切割术治疗特发性黄斑裂孔的手术效果。方法:7例(7眼)经眼底及OCT检查确诊为特发性黄斑裂孔,施行25G经结膜穿刺法玻璃体切割术,剥离视网膜前膜,眼内惰性气体填充,观察术后视力及裂孔封闭情况。结果:7例(7眼)黄斑裂孔均解剖复位,2眼视力无改善,5眼视力提高1～4行,随访1～6mo无裂孔复发者。结论:玻璃体切割术是治疗特发性黄斑裂孔的有效方法,经结膜小切口法较传统玻璃体切割术有明显的优势。     

Primary 25-gauge transconjunctival sutureless vitrectomy in pseudophakic retinal detachment

AIMS: There are few reports on 25-gauge transconjunctival sutureless vitrectomy (TSV) in cases of pseudophakic retinal detachment. We conducted this study to report the anatomic and functional outcomes of 25-gauge TSV in the treatment of primary pseudophakic retinal detachment (RD). DESIGN: Prospective, interventional case series. MATERIALS AND METHODS: Fifteen eyes of 15 patients with RD after cataract surgery with phacoemulsification were evaluated. Primary pseudophakic RDs with macular detachment and proliferative vitreoretinopathy Stage B or less were included in the study. Pars plana vitrectomy with the 25-gauge TSV system, perfluorocarbon liquid injection followed by air exchange, endolaser photocoagulation and sulfur hexafluoride gas (20%) injection were applied to all eyes. RESULTS: Mean follow-up time was 9.2 months (range, six to 12 months). Retinal reattachment with a single operation was achieved in 93% of eyes and with additional surgery, the retina was reattached in 100% of eyes. Preoperative visual acuity was less than 20/200 in all eyes (range, hand motions to 20/400). Postoperative visual acuity was 20/40 or better in eight eyes (53%) and between 20/50 and 20/200 in seven eyes (47%). No severe hypotony was encountered and no sutures were required to close the scleral and conjunctival openings. Postoperative complications were macular pucker in one eye (7%) and cystoid macular edema in another eye (7%). CONCLUSIONS: Primary 25-gauge TSV system appears to be an effective and safe procedure in the treatment of uncomplicated pseudophakic RD.     

25-G微创玻璃体视网膜手术后眼屈光稳定性

目的 对比分析25-gauge(G)微创玻璃体视网膜手术与20-G手术术后眼屈光稳定性.方法 前瞻性随机病例对照研究.选取121例(121眼)需行玻璃体视网膜手术的眼底病患者,根据随机数字表随机分为A、B两组.A组61眼采用常规20-G玻璃体切割手术,B组60眼采用25-G微创玻璃体切割手术,对比观察术前与术后1周、4周和12周视力、屈光度、角膜地形图改变.数据采用卡方检验、独立样本t检验、单因素方差分析、Mann-Whitney非参数检验进行分析.结果 术后1周和4周,B组视力优于A组(x2=8.81、6.65,P均＜0.05).A组术后屈光度向远视漂移,在术后12周回归至接近术前水平.B组术后屈光度向近视漂移.A组术后1周、4周、12周较术前改变的平均球镜度为(+1.93±0.07)D、(+1.06±0.04)D、(+0.15±0.03)D,较术前改变的平均散光度为(1.62±0.07)D、(1.05±0.05)D、(0.41±0.03)D.B组术后1周、4周、12周较术前改变的平均球镜度为(-0.06±0.02)D、(-0.04±0.03)D、(-0.03±0.02)D,较术前改变的平均散光度为(0.05±0.01)D、(0.03±0.01)D、(0.03±0.02)D.术后1周、4周、12周球镜度改变在两组中差异存在统计学意义(t=200.6、159.3、26.0,P均＜0.01).术后各时间段散光度改变在两组中差异存在统计学意义(t=173.4、156.3、82.3,P均＜0.01).A组角膜散光屈光率(SimK1-K2)、表面不对称指数(SAI)、表面规则指数(SRI)在各个时间点的差异有统计学意义(F=4.21、3.44、3.28,P＜0.05),而B组患者各角膜地形参数在术前、术后各时间段差异无统计学意义.A、B两组之间在术后短期内角膜SimK1-K2、SAI、SRI的改变量差异有统计学意义(U=51.5、45.5、47.0,P＜0.05).结论 与20-G常规玻璃体切割手术相比,25-G微创玻璃体视网膜手术后眼屈光稳定性更好,可获得更完善的视功能.     

Topical anesthesia in transconjunctival sutureless 25-gauge vitrectomy for macular-based disorders

PURPOSE: To evaluate the safety and feasibility of topical anesthesia in vitrectomy using the transconjunctival sutureless 25-gauge system (TSV 25G). METHODS: TSV 25G vitrectomy was performed prospectively in 46 eyes of 46 patients with macular-based disorders, including macular holes (n = 31), idiopathic epiretinal membranes (n = 11), and vitreoretinal traction syndrome (n = 4). Topical anesthesia was administered in each patient by instilling 2% Alcaine at 5 min intervals, three times before surgery. Additional Alcaine drops were given as a supplementation if needed during the operation. The levels of intraoperative analgesia were graded from 1 (adequate) to 3 (inadequate). RESULTS: Thirty-one patients (67.4%) tolerated the procedure well, with no additional anesthetic agent. Thirteen patients (28.3%) required additional topical anesthesia and 2 patients (4.3%) required a systemic sedative. Intraoperative pain occurred when the sclera was pierced by the microcannula and when sclera indentation was performed. No patient required additional retrobulbar or peribulbar anesthesia. There was no intraoperative complication which was specifically related to topical anesthesia. CONCLUSION: Topical anesthesia permits the successful management of some surgically less complex vitreoretinal disorders when the TSV 25G is used.     

无缝线无灌注25-G玻璃体手术系统治疗婴幼儿白内障的应用研究现状

后发性白内障是婴幼儿白内障术后最常见的并发症,为预防后发性白内障的形成,普遍采用的手术方式是白内障摘除、晶状体后囊膜切开联合前段玻璃体切除和人工晶状体植入.前段玻璃体切除仪是同步灌注、吸出与切除,切除最高频率为600次/min,切除头为18 G,术中、术后并发症多,操作难度大.扁平部20 G玻璃体切除需做2个巩膜穿刺口,拔管后需缝合,灌注液直接进入玻璃体腔,使玻璃体水化膨胀向前移动进入前房,对眼内组织扰动较大,而且20 G切除头相对婴幼儿眼球较大.25 G玻璃体切除最高频率为1500次/min,可将前段玻璃体整齐切除,减少了玻璃体牵拉和震动;只需做一个巩膜穿刺口,减少了术中出血,缩短了手术时间,同时也避免了术后由缝线污染引起的不适.本文就无缝线无灌注25 G手术治疗婴幼儿白内障的应用研究现状作一综述.     

Outcomes of transconjunctival sutureless 25-gauge vitrectomy with silicone oil infusion

PURPOSE: To evaluate the outcomes and complications of surgical management with 25-gauge pars plana vitrectomy (PPV) and silicone oil (SO) tamponade in complex vitreoretinal diseases. METHODS: Retrospective review of a consecutive, interventional case series at a single center. RESULTS: Thirty-five eyes of 35 patients were included in the study. The indications for vitrectomy included tractional retinal detachment (11 eyes), macular hole (6 eyes), proliferative vitreoretinopathy or recurrent retinal detachment (9 eyes), neovascular glaucoma (3 eyes), giant retinal tear (3 eyes), and pathologic myopia with epiretinal membrane or macular hole (3 eyes). All patients underwent 25-gauge PPV with either 1,000-centistoke (n = 31) or 5,000-centistoke (n = 4) SO tamponade infused through a 24-gauge angiocatheter. No intraoperative complications were noted. The median preoperative visual acuity was counting fingers (range, 20/50 to light perception). The median postoperative visual acuity after a median follow-up of 6 months (range, 1-19 months) was 20/200 (range, 20/30 to light perception). A small subconjunctival SO bleb was identified in two patients. Recurrent retinal detachment occurred in three patients. No significant complications relating to the use of SO in the setting of 25-gauge PPV occurred. CONCLUSIONS: Advances in 25-gauge PPV instrumentation have enabled expanding indications for 25-gauge PPV. 25-Gauge PPV with SO tamponade is safe and efficient and can be considered in the surgical management of complex vitreoretinal disease.     

Removal of silicone oil with 25-gauge transconjunctival sutureless vitrectomy system

PURPOSE: To report a new and simple technique for silicone oil removal from pars plana with 25-gauge (G) transconjunctival sutureless vitrectomy system (TSVS). METHODS: In this prospective, interventional clinical trial, 13 eyes underwent silicone oil (1000 centistokes) removal from pars plana passively, with 25-G TSVS, between January and May 2005. Main outcome measures were postoperative visual acuity, intraocular pressure (IOP), silicone oil removal time, complications, and number of sutured sites. RESULTS: In all eyes silicone oil was removed successfully under sub-Tenon (n = 12) and topical (n = 1) anesthesia. The mean silicone oil removal time was 7.27 +/- 0.48 minutes. No intraoperative complications were reported. No suture placement was necessary. Mean postoperative follow-up period was 3.92 +/- 1.49 (range: 3-7) months. Visual acuity improved or stabilized in 11 (84.61%) eyes. Retinal redetachment occurred in 2 (15.38%) eyes resulting in a decrease in vision. Decrease in postoperative IOP was found only at 2 hours (P = 0.003). Postoperatively, transient hypotony at 2 hours (n = 1) and transient vitreous hemorrhage (n = 1) were noted. There were no cases of choroidal detachment, endophthalmitis, clinically significant corneal endothelial decompensation, or macular edema. CONCLUSION: Removal of silicone oil of 1000 centistokes with 25-G transconjunctival sutureless sclerotomies was effective and safe.     

25-gauge transconjunctival sutureless vitrectomy system in the surgical management of children with posterior capsular opacification

PURPOSE: To evaluate the safety and efficacy of the 25-gauge transconjunctival sutureless vitrectomy (TSV) system in the surgical management of posterior capsular opacification (PCO) in pseudophakic children. METHODS: Pars plana membranectomy was performed for PCO in 10 pseudophakic eyes of six children (mean age 35.1 +/- 37.8 months; range 6-93 months) using the TSV system. Surgical technique, intraoperative problems and postoperative complications including wound leakage, hypotony and the need for suturing were recorded. RESULTS: Wound leakage and other intraoperative problems were not noted in any of the eyes. All eyes showed improvement of visual acuity from a mean of 6/67 before to 6/29 after surgery (P = 0.001). Mean postoperative intraocular pressure (IOP) was 7.8 +/- 3.1 mmHg (range: 3-10 mmHg). Four eyes (40%) had hypotony on the first postoperative day (IOP: 3-5 mmHg), which was transient in three eyes. One eye in a patient with uveitis had persistent hypotony, but hypotony was also present preoperatively, and the postoperative IOP returned to preoperative levels. This eye also developed recurrent PCO and a second capsulotomy was performed using the 25-gauge TSV system. CONCLUSIONS: Posterior capsulotomy using the 25-gauge TSV system appears to be a safe and effective approach in the management of PCO in pseudophakic children. Advantages include easier manipulation with the smaller instruments in these small eyes, and it can be considered in appropriate cases.     

25-Gauge transconjunctival sutureless vitrectomy

PURPOSE OF REVIEW: The history and development of 25-gauge transconjunctival sutureless vitrectomy are reviewed in this paper. The expanded spectrum of appropriate cases and recent innovations in vitrectomy surgery are discussed, as are longer-term outcomes and possible complications. RECENT FINDINGS: 25-Gauge pars plana vitrectomy has evolved significantly since its introduction in 2002, with newer instruments and novel techniques expanding the scope and improving outcomes in vitreoretinal surgery. Proper case selection is imperative, as the smaller scale of the instruments and decreased fluidics work most efficiently when extensive manipulation of intraocular tissue or significant membrane dissection is not required. Unique complications of 25-gauge surgery such as hypotony and a possible increased rate of endophthalmitis may be related to unsutured sclerotomies, and revisions in surgical approach may help to decrease these potentially devastating complications. SUMMARY: Clinical experience over the last several years has proven that this sutureless system is both safe and efficacious. Decreased surgical times, reduced postoperative inflammation, and more rapid patient recovery have all contributed to an increased acceptance of 25-gauge vitrectomy by retinal physicians.     

Repair of primary rhegmatogenous retinal detachment using 25-gauge transconjunctival sutureless vitrectomy

PURPOSE:: To evaluate the anatomical and visual outcomes of primary rhegmatogenous retinal detachment repairs performed using 25-gauge transconjunctival sutureless vitrectomy. METHODS:: A retrospective, noncomparative interventional case series including 53 consecutive eyes of 52 patients who underwent 25-gauge transconjunctival sutureless vitrectomy to repair primary rhegmatogenous retinal detachment was performed. Variables collected for the study were patient demographics, lens status, preoperative visual acuity, and macular status. Outcome measures included single-operation anatomical success rate, final anatomical success rate, postoperative visual acuity, and surgical complications. RESULTS:: The retina was reattached with a single operation in 39 (74%) of 53 eyes. The final anatomical success rate was 100%. The mean time to redetachment was 72 days (range, 13-334 days). Proliferative vitreoretinopathy (64%) and development of new retinal breaks (43%) were the most common reasons associated with redetachment. Mean visual acuity improved from 20/100 to 20/60 (P = 0.001); 55% of eyes had final vision of 20/40 or better. Three eyes (6%) developed postoperative choroidal hemorrhage. Three eyes (6%) developed visually significant macular pucker that required surgery. No postoperative hypotony or endophthalmitis was observed. CONCLUSIONS:: Repair of primary rhegmatogenous retinal detachments using 25-gauge transconjunctival sutureless vitrectomy resulted in excellent final anatomical success rate and postoperative visual outcomes. However, redetachments due to new tears and/or proliferative vitreoretinopathy resulted in a lower single-operation success rate than those reported with 20-gauge systems.     

Visual outcomes with 23-gauge transconjunctival sutureless vitrectomy

PURPOSE: To evaluate the outcomes of patients treated with 23-gauge transconjunctival sutureless vitrectomy for various posterior segment conditions. METHODS: A retrospective chart review of 81 consecutive 23-gauge vitrectomy cases done by a single vitreoretinal surgeon for various posterior segment conditions was done. All surgery was performed using the two-step 23-gauge system developed by Dutch Ophthalmic Research Center. All patients had at least 3-month follow-up. Main outcome measures included visual acuity, intraocular pressure, and operative complications. RESULTS: Mean follow-up was 6.5 months (range 3-9 months). Mean overall preoperative visual acuity was 20/150 and final acuity was 20/70 (P < 0.0001). Mean intraocular pressure on postoperative day 1 was 14 mmHg (range 6-28 mmHg). There was a single case of intraoperative retinal tear that required treatment with cryotherapy. Twenty eyes of 48 phakic eyes (42%) had worsening of cataracts in the postoperative period. There were no postoperative complications of endophthalmitis or retinal detachment. CONCLUSIONS: Twenty-three-gauge transconjunctival sutureless vitrectomy is an effective surgical technique in the management of vitreoretinal diseases. Complications were rare and compared favorably with published literature on 20-gauge and 25-gauge surgery.