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.     

Office-based sutureless transconjunctival pars plana vitrectomy

PURPOSE: This is a preliminary report to describe our technique of office-based vitrectomy (OVIT) and to report the incidence of complications over a 6-year period. METHODS: In a retrospective, noncomparative case series, OVIT was performed on 225 patients in four participating offices. Each patient was operated on with a 23-gauge vitreous cutter that the authors have developed. They have also developed a 23-gauge transconjunctival infusion needle device. Diagnoses included endophthalmitis, uveitis, intravitreal lens fragments, ghost cell glaucoma, and rhegmatogenous retinal detachment. RESULTS: The surgical goal was accomplished in all cases, but supplemental office procedures were required for two eyes, and a scleral buckle was necessary in one eye. There were 15 complications in 14 eyes: "fish-egg" gas bubbles (one eye), intraocular hemorrhage (nine eyes), choroidal detachment (two eyes), new retinal breaks (one eye), retinal detachment (one eye), and temporary elevation of intraocular pressure (one eye). The hemorrhages, choroidal detachments, and fish-egg bubbles all resolved spontaneously. CONCLUSION: Office-based sutureless transconjunctival pars plana vitrectomy, with infusion when needed, is an effective operation for selected diseases of the posterior segment. In a multicenter series of 225 eyes, there were 15 complications in 14 (6%) eyes. Two of the complications were successfully managed with additional office procedures; one was managed in the operating room; and 12 resolved spontaneously.     

Keratometric alterations following the 25‐gauge transconjunctival sutureless pars plana vitrectomy versus the conventional pars plana vitrectomy

Purpose: To assess the alterations in keratometric astigmatism following the 25‐gauge transconjunctival sutureless pars plana vitrectomy versus the conventional pars plana vitrectomy. Methods: Sixteen consecutive patients were enrolled into the study. Conventional vitrectomy was applied to eight of the cases and 25‐gauge transconjunctival sutureless vitrectomy was performed in eight patients. Keratometry was performed before and after the surgery. Results: In the 25‐gauge transconjunctival sutureless pars plana vitrectomy group, statistically significant changes were not observed in the corneal curvature in any post‐operative follow‐up measurement (p > 0.05); whereas in the conventional pars plana vitrectomy group, statistically significant changes were observed in the first postoperative day (p = 0.01) and first postoperative month (p = 0.03). We noted that these changes returned to baseline in three months (p = 0.26). Conclusion: Both 25‐gauge transconjunctival sutureless and conventional pars plana vitrectomy are effective surgical modalities for selected diseases of the posterior segment. Surgical procedures are critical for the visual rehabilitation of the patients. The post‐operative corneal astigmatism of the vitrectomised eyes can be accurately determined at least two months post‐operatively     

经结膜免缝合20G穿刺套管刀行常规玻璃体切割术的临床观察

目的观察经结膜免缝合20G穿刺套管刀行常规玻璃体切割术的临床效果。方法回顾性分析行玻璃体切割手术62例63只眼的临床资料。按手术方式分为2组,A组：20G经结膜免缝合穿刺套管完成常规玻璃体切割术33例34只眼。男性19例,女性14例;年龄17～75岁,平均年龄52.3岁;平均视力0.04;平均眼压18.25 mm Hg(1 mm Hg=0.133 kPa)。糖尿病视网膜病变（DR）13例;玻璃体积血9例;硅油眼取油剥膜 2例;复杂视网膜脱离9例;黄斑前膜剥离1例。B组：常规20G切口玻璃体切割术29例29只眼。男性13例,女性19例;年龄24～69岁,平均年龄49.5岁;平均视力0.02,平均眼压 17.50 mm Hg。糖尿病视网膜病变10例;单纯玻璃体积血8例;视网膜脱离5例;陈旧性视网膜脱离玻璃体切割联合巩膜环扎2例;硅油眼取油剥膜注气4例。A组34只眼中行眼内激光光凝21只眼,巩膜外冷冻封闭裂孔9只眼;惰性气体填充3只眼,硅油填充15只眼。手术后记录并分析切口渗漏情况,医源性裂孔如发生率及记录患者舒适度。计数资料采用χ2检验。结果 A组34只眼中31只眼穿刺口自闭性良好,无需特别处理,切口无渗漏,手术后舒适度好,3只惰性气体填充眼需压迫3～5 min,且颞下切口均有气体溢出,缝合1针。B组所有患者巩膜结膜切口均8 0丝线缝合,无切口渗漏。异物感明显刺激症状重;舒适度两组比较,差异有统计学意义 (χ2=50.56,P＜0.01);A 组34只眼均未发生医源性裂孔,B组2只眼发生穿刺口旁锯齿缘裂孔,两组比较,差异有统计学意义(χ2=4.15,P＜0.05)。结论经结膜免缝合20G穿刺套管刀行常规玻璃体切割术,使常规玻璃体切割手术简单快捷,显著的减少了医缘性裂孔发生率,使手术更安全。     

应用25G玻璃体切除术治疗白内障术后眼前段拥挤征

目的 评价25G经结膜无缝合玻璃体切除手术系统(25G TSV)在白内障行超声乳化联合人工晶状体植入术后眼前段拥挤征治疗中的应用价值.方法 采用25G TSV对15例(15眼)白内障术后眼前段拥挤征行人工晶状体后囊切开+前段玻璃体切除术,术后随访6～12个月,平均(8.0±1.5)个月,记录术后视力、眼压、前房深度,观察角膜、瞳孔、人工晶状体及并发症情况.结果 所有手术均顺利完成.术后视力有不同程度提高,术前及术后l周、末次随访时平均最佳矫正视力分别为0.05±0.02、0.2±0.1、0.4±0.1,治疗前后相比,差异有统计学意义(P=0.00),术后1周、末次随访时平均眼压分别为(17.3±1.8)mm Hg和(16.5±1.3)mm Hg,较术前平均眼压(40.1±7.5)mmHg明显下降,差异有统计学意义(P=0.00).术前及术后1周、末次随访时中央前房深度分别为(0.69 ±0.17)mm、(2.71±0.43)mm、(2.85±0.52)mm,治疗前后相比,差异有统计学意义(P=0.00).所有病例术后角膜水肿消退,瞳孔圆,人工晶状体后囊中央均形成直径为3.0～4.0 mm的圆孔,术中及术后均未见明显并发症发生.结论 25G经结膜无缝合玻璃体切除能有效解除白内障术后眼前段拥挤征,手术创伤小,安全度高.     

A new non-trocar system for 25-gauge transconjunctival pars plana vitrectomy

PURPOSE: To introduce a new non-trocar system for 25-gauge transconjunctival pars plana vitrectomy (PPV). DESIGN: Study of a new surgical instrument. METHODS: This new non-trocar system for 25-gauge transconjunctival PPV consists of a contact lens ring featuring four projections containing 1.0-mm diameter holes located 3.0 mm from the ring edge, a wedge-shaped 25-gauge infusion cannula, and two plugs. RESULTS: The ring is fixed with 7-0 silk sutures at the 3- and 9-o'clock positions on the limbus. Using the 25-gauge needle, three conjunctival and scleral incisions (n = 3) are made at the projection holes located inferotemporally, superonasally, and superotemporally. No intra- or postoperative complications were encountered in 14 patients treated by this non-trocar 25-gauge transconjunctival PPV. CONCLUSION: Using the system introduced here, 25-gauge transconjunctival PPV can be performed without suturing sclerotomies and without intra- or postoperative complications.     

The efficacy of retrobulbar block anesthesia only in pars plana vitrectomy and transconjunctival sutureless vitrectomy.

BACKGROUND AND OBJECTIVE: To evaluate the adequacy of retrobulbar block anesthesia only in vitreoretinal surgery. PATIENTS AND METHODS: The study involved 90 patients, 25 who underwent 25-gauge transconjunctival sutureless vitrectomy and 65 who underwent 20-gauge standard pars plana vitrectomy. Twenty-five of the 90 patients also underwent combined phacoemulsification and posterior intraocular lens implantation. The efficacy of retrobulbar block anesthesia only was assessed by monitoring vital signs during surgery, reviewing patient responses to a questionnaire regarding their experience during surgery, and analyzing surgical outcomes. RESULTS: Four patients complained of moderate pain during surgery, but no patient complained of severe pain. Infiltrative anesthesia was additionally required in 14 patients. No patient experienced intraoperative complications due to head movement. Increased systolic blood pressure greater than 15 mm Hg occurred in 11 patients and increased respiratory rate by 3 breaths per minute or greater occurred in 7 patients. Anatomical and functional success rates were 95% and 80%, respectively. Complications included manageable retrobulbar bleeding (1 patient) and postoperative neovascular glaucoma (2 patients). CONCLUSION: Vitreoretinal surgery, particularly 25-gauge transconjunctival sutureless vitrectomy, can be safely and efficiently performed under retrobulbar block anesthesia only. Retrobulbar block anesthesia only could become a more acceptable anesthesia for vitreoretinal surgery for selected patients.     

20-gauge transconjunctival pars plana vitrectomy.

This article describes a transconjunctival technique for pars plana vitrectomy using 20-gauge instruments. Sclerotomies are performed directly through the conjunctiva, Tenon's capsule, and sclera with a 19-gauge microvitreoretinal blade. A sutureless 20-gauge infusion cannula is then inserted and pars plana vitrectomy is performed in a standardized fashion using 20-gauge instruments. Each sclerotomy and its corresponding conjunctival incision is closed with a single stitch using a 7-0 polyglactin suture. This transconjunctival technique is a reasonable alternative surgical approach to minimize surgical trauma of tissues (eg, conjunctiva) and hasten postoperative recovery without the additional risks and costs associated with 25-gauge pars plana vitrectomy.     

Self-sealing sclerotomies for sutureless pars plana vitrectomy

OBJECTIVE: To determine the efficacy of self-sealing pars plana sclerotomies for vitrectomy and to identify complications associated with this new technique. METHOD: There were 150 self-sealing sclerotomies performed in 50 patients undergoing pars plana vitrectomy between October 1996 and March 1998. RESULTS: Of the 150 sclerotomies, 115 (76.6%) did not require suturing while 35 (23.3%) were closed with one radial 7.0 vicryl suture. The scleral tunnel incisions ensured minimal loss of intraocular fluids during instrument exchange and scleral plugs were not required to avoid ocular hypotony during scleral indentation. Distortion of scleral flap incisions requiring a suture were commonly seen in procedures using multiple instrumentations and extensive explants. CONCLUSIONS: Sutureless sclerotomies are simple to perform, save operative time, and reduce the risk of peroperative hypotony following removal of instruments or the infusion cannula. The technique reduces postoperative inflammation, suture-related problems including astigmatism, and allows more rapid rehabilitation.     

Modified sutureless sclerotomies in pars plana vitrectomy

PURPOSE: To study the effectiveness and safety of a modified sutureless sclerotomy technique in pars plana vitrectomy. METHODS: We rotated the scleral tunnels of the original sutureless sclerotomy technique through 90 degrees, thus rendering them parallel to the corneoscleral limbus. This modified technique was applied to 25 consecutive eyes (25 patients) that had pars plana vitrectomy during a 2-month period. RESULTS: Twenty (80%) of 25 eyes (25 patients) did not require suturing of the sclerotomy sites associated with pars plana vitrectomy. Eight (11%) of 75 sclerotomy sites required suturing to ensure watertight closure. No clinically significant complications were encountered. CONCLUSION: The modified sutureless sclerotomy technique was found to be safe, more convenient, and easier to perform, especially in eyes with small interpalpebral space.     

Modified sutureless sclerotomies for pars plana vitrectomy

PURPOSE: To describe a modified technique for performing sutureless sclerotomies for pars plana vitrectomy and to examine its efficacy and safety. DESIGN: Retrospective, interventional case series. METHODS: Self-sealing sclerotomies were created in 35 consecutive cases by oblique penetration of the sclera with a 19G MVR blade. RESULTS: All but two (2.9%) of the sclerotomies were watertight without suturing at the end of surgery. A conjunctival bleb was observed during the first postoperative week in one case, but it resolved without intervention. CONCLUSIONS: Construction of sutureless sclerotomies by this technique is simpler and more rapid compared with previously described techniques. The resulting sclerotomies are more resistant to stretching and tearing of the tunnel's roof, they rarely need suturing, and insertion of instruments is facilitated.     

Modified sutureless sclerotomies in pars plana vitrectomy

PURPOSE: To report late suture migration as a complication of blepharoptosis surgery. METHOD: Case reports. RESULTS: After upper eyelid blepharoptosis repair, two eyes of two patients developed unusual foreign body reactions and ulceration in the conjunctiva caused by migration of nonabsorbable suture from the levator aponeurosis to the upper conjunctival fornix. The foreign body caused eyelid edema, papillary changes in the upper tarsal conjunctiva, recurrent blepharoptosis, and a foreign body sensation that started more than 3 months after the surgery and persisted until the suture was removed. The sutures, hidden in edematous conjunctiva of the superior fornix, eluded detection. CONCLUSIONS: Foreign body reaction secondary to suture migration is an uncommon complication of blepharoptosis repair.