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The safety and efficacy of transconjunctival sutureless 23-gauge vitrectomy.

Kim MJ, Park KH, Hwang JM, Yu HG, Yu YS, Chung H - Korean J Ophthalmol (2007)

Bottom Line: Intraoperative suture placement was necessary in 3 eyes (7.5%).The median BCVA improved from 20/400 (LogMAR, 1.21+/-0.63) to 20/140 (LogMAR, 0.83+/-0.48) at 1 week (p=0.003), 20/100 (LogMAR, 0.85+/-0.65) at 1 month (p=0.002), 20/100 (LogMAR, 0.73+/-0.6) at 3 months (p=0.001).In 1 eye, IOP was 5 mmHg at 2 hours and 4 mmHg at 5 hours, but none of the eyes showed hypotony after 1 postoperative day.

View Article: PubMed Central - PubMed

Affiliation: Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea.

ABSTRACT

Purpose: To evaluate the efficacy and safety of vitreoretinal surgery using a 23-gauge transconjunctival sutureless vitrectomy (TSV) system for various vitreoretinal diseases.

Methods: A retrospective, consecutive, interventional case series was performed for 40 eyes of 40 patients. The patients underwent vitreoretinal procedures using the 23-gauge TSV system, including idiopathic epiretinal membrane (n=7), vitreous hemorrhage (n=11), diabetic macular edema (n=10), macular hole (n=5), vitreomacular traction syndrome (n=5), diabetic tractional retinal detachment (n=1), and rhegmatogenous retinal detachment (n=1). Best corrected visual acuity (BCVA), intraocular pressure (IOP), and intra- and post-operative complications were evaluated.

Results: Intraoperative suture placement was necessary in 3 eyes (7.5%). The median BCVA improved from 20/400 (LogMAR, 1.21+/-0.63) to 20/140 (LogMAR, 0.83+/-0.48) at 1 week (p=0.003), 20/100 (LogMAR, 0.85+/-0.65) at 1 month (p=0.002), 20/100 (LogMAR, 0.73+/-0.6) at 3 months (p=0.001). In 1 eye, IOP was 5 mmHg at 2 hours and 4 mmHg at 5 hours, but none of the eyes showed hypotony after 1 postoperative day. No serous postoperative complications were observed during a mean follow-up of 8.4+/-3.4 months (range 3-13 months)

Conclusions: The 23-gauge TSV system shows promise as an effective and safe technique for a variety of vitreoretinal procedures. It appears to be a less traumatic, more convenient alternative to 20-gauge vitrectomy in some indications.

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Related in: MedlinePlus

Comparison among the aspiration rates of balanced saline solution for 20-, 23- and 25-gauge ocutomes. The overall average aspiration rate of the 20-gauge ocutome was 3.2- and 5.9-fold greater than that of the 23- and 25-gauge ocutomes, respectively. The average aspiration rate of the 23-gauge ocutome was 1.9-fold greater than that of the 25-gauge ocutome.
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Figure 5: Comparison among the aspiration rates of balanced saline solution for 20-, 23- and 25-gauge ocutomes. The overall average aspiration rate of the 20-gauge ocutome was 3.2- and 5.9-fold greater than that of the 23- and 25-gauge ocutomes, respectively. The average aspiration rate of the 23-gauge ocutome was 1.9-fold greater than that of the 25-gauge ocutome.

Mentions: We additionally did an in vitro experiment to evaluate the efficacy of 23-gauge infusion cannula and vitreous cutter following the method as described by Fujii et al.1 To compare the effectiveness of the 23- (Reusable Infusion Cannula, 0.75 mm [23 G], DORC, Zuidland, Holland), 20- (BD Infusion Cannula, 4 mm, 0.90 mm [20 G], BD, Waltham, USA) and 25-gauge (25-gauge infusion cannula, Alcon Surgical, Texas, USA) infusion cannulas, we measured the time to infuse 10ml of balanced saline solution (BSS) at a bottle height of 40, 60, 80, 100 and 120 cm. We also measured the time to aspirate 5 ml of BSS with 20- (Accurus 2500, Alcon Surgical, Texas, USA), 23- (Pneumatic Vitrectomy, 23-gauge, DORC, Zuidland, Holland) and 25-gauge (Accurus 25-gauge, Alcon Surgical, Texas, USA) ocutomes by the aspiration setting of 100, 200, 300, 400, and 500 mmHg using the same Accurus® Vitreoretinal Surgical System (Alcon Surgical, Texas, USA). Individual measurements were replicated 5 times to ensure reliability and reproducibility. In general, the average infusion rate of the 23-gauge cannula was 1.7- and 2.8-fold greater than that of the 20- and 25-gauge cannulas, respectively (Fig. 4) and the average aspiration rate of the 20-gauge ocutome was 3.2- and 5.9-fold greater than that of the 23- and 25-gauge ocutomes, respectively (Fig. 5). Although no controlled comparison study was performed in vivo, we can expect that the surgical time with the 23-gauge system might be at least the same as or less than that of the 25-gauge system. Although the inner diameter of 23- gauge cannula is smaller than that of 20-gauge system (0.65 mm vs. 0.80 mm), the infusion rate with the 23-gauge system was not only greater than that of the 25-gauge system, but also than that of the 20-gauge system. We speculated that there would be a bottle neck effect in 20 gauge infusion system because, there is acute narrowing of inner diameter between infusion tube and infusion tip at the joint of the flange. In 23 G system, the infusion tube is directely connected to microcannula with funnel-shaped opening which may reduce bottle neck effect. Fujii et al.2 insisted that the 25-gauge infusion cannula should not be used in conjunction with a 20-gauge vitreous cutter, because it may result in hypotony during aspiration resulting from the functional discrepancy between the infusion and aspiration rates of both systems. We could expect that no such concern will be necessary with the 23-gauge system.


The safety and efficacy of transconjunctival sutureless 23-gauge vitrectomy.

Kim MJ, Park KH, Hwang JM, Yu HG, Yu YS, Chung H - Korean J Ophthalmol (2007)

Comparison among the aspiration rates of balanced saline solution for 20-, 23- and 25-gauge ocutomes. The overall average aspiration rate of the 20-gauge ocutome was 3.2- and 5.9-fold greater than that of the 23- and 25-gauge ocutomes, respectively. The average aspiration rate of the 23-gauge ocutome was 1.9-fold greater than that of the 25-gauge ocutome.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2629884&req=5

Figure 5: Comparison among the aspiration rates of balanced saline solution for 20-, 23- and 25-gauge ocutomes. The overall average aspiration rate of the 20-gauge ocutome was 3.2- and 5.9-fold greater than that of the 23- and 25-gauge ocutomes, respectively. The average aspiration rate of the 23-gauge ocutome was 1.9-fold greater than that of the 25-gauge ocutome.
Mentions: We additionally did an in vitro experiment to evaluate the efficacy of 23-gauge infusion cannula and vitreous cutter following the method as described by Fujii et al.1 To compare the effectiveness of the 23- (Reusable Infusion Cannula, 0.75 mm [23 G], DORC, Zuidland, Holland), 20- (BD Infusion Cannula, 4 mm, 0.90 mm [20 G], BD, Waltham, USA) and 25-gauge (25-gauge infusion cannula, Alcon Surgical, Texas, USA) infusion cannulas, we measured the time to infuse 10ml of balanced saline solution (BSS) at a bottle height of 40, 60, 80, 100 and 120 cm. We also measured the time to aspirate 5 ml of BSS with 20- (Accurus 2500, Alcon Surgical, Texas, USA), 23- (Pneumatic Vitrectomy, 23-gauge, DORC, Zuidland, Holland) and 25-gauge (Accurus 25-gauge, Alcon Surgical, Texas, USA) ocutomes by the aspiration setting of 100, 200, 300, 400, and 500 mmHg using the same Accurus® Vitreoretinal Surgical System (Alcon Surgical, Texas, USA). Individual measurements were replicated 5 times to ensure reliability and reproducibility. In general, the average infusion rate of the 23-gauge cannula was 1.7- and 2.8-fold greater than that of the 20- and 25-gauge cannulas, respectively (Fig. 4) and the average aspiration rate of the 20-gauge ocutome was 3.2- and 5.9-fold greater than that of the 23- and 25-gauge ocutomes, respectively (Fig. 5). Although no controlled comparison study was performed in vivo, we can expect that the surgical time with the 23-gauge system might be at least the same as or less than that of the 25-gauge system. Although the inner diameter of 23- gauge cannula is smaller than that of 20-gauge system (0.65 mm vs. 0.80 mm), the infusion rate with the 23-gauge system was not only greater than that of the 25-gauge system, but also than that of the 20-gauge system. We speculated that there would be a bottle neck effect in 20 gauge infusion system because, there is acute narrowing of inner diameter between infusion tube and infusion tip at the joint of the flange. In 23 G system, the infusion tube is directely connected to microcannula with funnel-shaped opening which may reduce bottle neck effect. Fujii et al.2 insisted that the 25-gauge infusion cannula should not be used in conjunction with a 20-gauge vitreous cutter, because it may result in hypotony during aspiration resulting from the functional discrepancy between the infusion and aspiration rates of both systems. We could expect that no such concern will be necessary with the 23-gauge system.

Bottom Line: Intraoperative suture placement was necessary in 3 eyes (7.5%).The median BCVA improved from 20/400 (LogMAR, 1.21+/-0.63) to 20/140 (LogMAR, 0.83+/-0.48) at 1 week (p=0.003), 20/100 (LogMAR, 0.85+/-0.65) at 1 month (p=0.002), 20/100 (LogMAR, 0.73+/-0.6) at 3 months (p=0.001).In 1 eye, IOP was 5 mmHg at 2 hours and 4 mmHg at 5 hours, but none of the eyes showed hypotony after 1 postoperative day.

View Article: PubMed Central - PubMed

Affiliation: Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea.

ABSTRACT

Purpose: To evaluate the efficacy and safety of vitreoretinal surgery using a 23-gauge transconjunctival sutureless vitrectomy (TSV) system for various vitreoretinal diseases.

Methods: A retrospective, consecutive, interventional case series was performed for 40 eyes of 40 patients. The patients underwent vitreoretinal procedures using the 23-gauge TSV system, including idiopathic epiretinal membrane (n=7), vitreous hemorrhage (n=11), diabetic macular edema (n=10), macular hole (n=5), vitreomacular traction syndrome (n=5), diabetic tractional retinal detachment (n=1), and rhegmatogenous retinal detachment (n=1). Best corrected visual acuity (BCVA), intraocular pressure (IOP), and intra- and post-operative complications were evaluated.

Results: Intraoperative suture placement was necessary in 3 eyes (7.5%). The median BCVA improved from 20/400 (LogMAR, 1.21+/-0.63) to 20/140 (LogMAR, 0.83+/-0.48) at 1 week (p=0.003), 20/100 (LogMAR, 0.85+/-0.65) at 1 month (p=0.002), 20/100 (LogMAR, 0.73+/-0.6) at 3 months (p=0.001). In 1 eye, IOP was 5 mmHg at 2 hours and 4 mmHg at 5 hours, but none of the eyes showed hypotony after 1 postoperative day. No serous postoperative complications were observed during a mean follow-up of 8.4+/-3.4 months (range 3-13 months)

Conclusions: The 23-gauge TSV system shows promise as an effective and safe technique for a variety of vitreoretinal procedures. It appears to be a less traumatic, more convenient alternative to 20-gauge vitrectomy in some indications.

Show MeSH
Related in: MedlinePlus