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Combination 20 and 23-gauge transconjunctival vitrectomy: a new approach.

Kumar A, Kakkar A, Jindal S, Rajesh R - Indian J Ophthalmol (2009 Nov-Dec)

Bottom Line: The advent of smaller gauge instrumentation allows for minimally invasive vitreoretinal surgery (MIVS) as compared to conventional pars plana vitrectomy.Sutureless posterior segment surgery has the advantages of faster wound healing, minimal surgical trauma, decreased convalescence period besides reduced postoperative astigmatism; however, slower gel removal and limited peripheral vitreous dissection are disadvantages with smaller gauge systems.We herein describe a new technique combining 23-gauge and 20-gauge vitrectomy to improve the effectiveness and outcomes of vitreoretinal surgery.

View Article: PubMed Central - PubMed

Affiliation: Department of Vitreous Retina service, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, AIIMS, New Delhi-11 00 29, India.

ABSTRACT
The advent of smaller gauge instrumentation allows for minimally invasive vitreoretinal surgery (MIVS) as compared to conventional pars plana vitrectomy. Sutureless posterior segment surgery has the advantages of faster wound healing, minimal surgical trauma, decreased convalescence period besides reduced postoperative astigmatism; however, slower gel removal and limited peripheral vitreous dissection are disadvantages with smaller gauge systems. We herein describe a new technique combining 23-gauge and 20-gauge vitrectomy to improve the effectiveness and outcomes of vitreoretinal surgery.

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Related in: MedlinePlus

Two 23G openings, namely infusion port and superotemporal cannula visible, along with a single superonasal 20G port visible with a scleral plug in place
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Figure 0002: Two 23G openings, namely infusion port and superotemporal cannula visible, along with a single superonasal 20G port visible with a scleral plug in place

Mentions: All patients received preoperative sedation and local anesthesia consisting of a peribulbar injection of 10 ml of a 50:50 mixture of 2% lidocaine and 0.15% bupivacaine. A 23G two-port setup for infusion and illumination (DORC, Zuidland, The Netherlands) was used along with a 20G vitrectomy through a third port. For the 23G opening, the conjunctiva was displaced 1-3 mm with a pressure plate with a central opening 3.5 mm from the edge. The 23G 45° angled microvitreoretinal blade (Bectin-Dickinson, USA) was inserted through the conjunctiva and sclera parallel and 3.5 mm posterior to the limbus through the central opening. A trocar-cannula was then inserted along the blade track while maintaining apposition of conjunctival and scleral opening with the pressure plate, the 23G infusion cannula was left inserted through the wound while the trocar was removed [Fig. 1]. Another similar port was made for the illumination probe. The third port included a localized peritomy and sclerotomy with a 20G microvitreoretinal blade [Fig. 2]. The hypotony using a combined 20-23G vitrectomy was best managed by increasing infusion bottle height to 50-60 cm and lowering suction settings to 75-100 mm Hg. Eyes being injected with silicon oil at the end of surgery had 1000cs silicone oil injected manually through the 23G infusion line. At the end of the surgery, 23G cannulae were removed and the site inspected for any wound leak which was sutured with a single stitch, only if found leaking, while the single 20G opening was sutured with 7-0 Vicryl.


Combination 20 and 23-gauge transconjunctival vitrectomy: a new approach.

Kumar A, Kakkar A, Jindal S, Rajesh R - Indian J Ophthalmol (2009 Nov-Dec)

Two 23G openings, namely infusion port and superotemporal cannula visible, along with a single superonasal 20G port visible with a scleral plug in place
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2812766&req=5

Figure 0002: Two 23G openings, namely infusion port and superotemporal cannula visible, along with a single superonasal 20G port visible with a scleral plug in place
Mentions: All patients received preoperative sedation and local anesthesia consisting of a peribulbar injection of 10 ml of a 50:50 mixture of 2% lidocaine and 0.15% bupivacaine. A 23G two-port setup for infusion and illumination (DORC, Zuidland, The Netherlands) was used along with a 20G vitrectomy through a third port. For the 23G opening, the conjunctiva was displaced 1-3 mm with a pressure plate with a central opening 3.5 mm from the edge. The 23G 45° angled microvitreoretinal blade (Bectin-Dickinson, USA) was inserted through the conjunctiva and sclera parallel and 3.5 mm posterior to the limbus through the central opening. A trocar-cannula was then inserted along the blade track while maintaining apposition of conjunctival and scleral opening with the pressure plate, the 23G infusion cannula was left inserted through the wound while the trocar was removed [Fig. 1]. Another similar port was made for the illumination probe. The third port included a localized peritomy and sclerotomy with a 20G microvitreoretinal blade [Fig. 2]. The hypotony using a combined 20-23G vitrectomy was best managed by increasing infusion bottle height to 50-60 cm and lowering suction settings to 75-100 mm Hg. Eyes being injected with silicon oil at the end of surgery had 1000cs silicone oil injected manually through the 23G infusion line. At the end of the surgery, 23G cannulae were removed and the site inspected for any wound leak which was sutured with a single stitch, only if found leaking, while the single 20G opening was sutured with 7-0 Vicryl.

Bottom Line: The advent of smaller gauge instrumentation allows for minimally invasive vitreoretinal surgery (MIVS) as compared to conventional pars plana vitrectomy.Sutureless posterior segment surgery has the advantages of faster wound healing, minimal surgical trauma, decreased convalescence period besides reduced postoperative astigmatism; however, slower gel removal and limited peripheral vitreous dissection are disadvantages with smaller gauge systems.We herein describe a new technique combining 23-gauge and 20-gauge vitrectomy to improve the effectiveness and outcomes of vitreoretinal surgery.

View Article: PubMed Central - PubMed

Affiliation: Department of Vitreous Retina service, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, AIIMS, New Delhi-11 00 29, India.

ABSTRACT
The advent of smaller gauge instrumentation allows for minimally invasive vitreoretinal surgery (MIVS) as compared to conventional pars plana vitrectomy. Sutureless posterior segment surgery has the advantages of faster wound healing, minimal surgical trauma, decreased convalescence period besides reduced postoperative astigmatism; however, slower gel removal and limited peripheral vitreous dissection are disadvantages with smaller gauge systems. We herein describe a new technique combining 23-gauge and 20-gauge vitrectomy to improve the effectiveness and outcomes of vitreoretinal surgery.

Show MeSH
Related in: MedlinePlus