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Transconjunctival Sutureless 23-gauge Vitrectomy for Vitreoretinal Diseases: Outcome of 30 Consecutive Cases.

El-Batarny AM - Middle East Afr J Ophthalmol (2008)

Bottom Line: Main outcome measures included surgical success, visual acuity, intraocular pressure, and operative complications.Subconjunctival silicone oil reported in one eye (3.3%).The safety profile compared favorably with published rates for 25-gauge systems.

View Article: PubMed Central - PubMed

Affiliation: Department of Ophthalmology, Magrabi Eye and Ear Hospital, Muscat, Sultanate of Oman.

ABSTRACT

Background: To describe the initial experience, effectiveness, and safety profile of 23-gauge instrumentation for a variety of vitreoretinal conditions.

Methods: A retrospective review of 30 consecutive 23-gauge vitrectomy cases done by a single vitreoretinal surgeon for various posterior segment conditions was done. All surgeries were performed using the two-step 23-gauge system developed by Dutch Ophthalmic Research Center (DORC). All patients had at least 3-month follow-up. Main outcome measures included surgical success, visual acuity, intraocular pressure, and operative complications.

Results: Mean follow-up was 7.7 months (range 3-12 months). Indications for surgery included rhegmatogenous retinal detachment (n=8), nonclearing vitreous hemorrhage (n=6), tractional retinal detachment (n=5), macular hole (n=5), epiretinal membrane (n=3), retained lens fragments (n=2) and endophthalmitis (n=1). Gas tamponade was used in 18 eyes (60%) and silicone oil in six eyes (20%). Mean overall preoperative visual acuity was 20/1053 and final acuity was 20/78 (P = 0.001). Mean intraocular pressure after 6 hours was 15.1mmHg (range 4-25 mmHg) and on postoperative day one was 14.5 mmHg (range 2-21 mmHg). Four eyes (13.3%) required suturing of sclerotomy intraoperatively. Conversion to 20-gauge was done in one eye (3.3%). Hypotony was reported in one eye (3.3%) postoperatively. Subconjunctival silicone oil reported in one eye (3.3%). There were no postoperative complications of endophthalmitis, retinal or choroidal detachment.

Conclusion: 23-gauge transconjunctival sutureless vitrectomy was effective in the management of wide variety of vitreoretinal surgical indications. The safety profile compared favorably with published rates for 25-gauge systems.

No MeSH data available.


Related in: MedlinePlus

Transconjunctival insertion of 23- gauge cannulas. A, A toothed pressure plate is used to displace the conjunctiva and stabilize the globe. The center of the plate is 3.5 mm from the limbus. B, A 45° angled 23-gauge microvitreoretinal blade is inserted in the conjunctiva and sclera at 20° angle, parallel to the limbus. C, Insertion of blunt trocar and cannula through the scleral incision in the center of pressure plate. D, Removal of pressure plate. E, the blunt trocar is removed and a 23-gauge infusion cannula is inserted. F, Introduction of upper nasal cannula with a valve fitting on its port. G, The cannula is fixed with a special forceps and the trocar is removed. H, Twenty three gauge cutter and light probe are inserted in upper ports through the valves. I, One of the Chandelier twin light fiberoptics is inserted through 27- gauge needle puncture into the 23- gauge infusion cannula to create an illuminated infusion cannula for bimanual maneuvers.
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Figure 0001: Transconjunctival insertion of 23- gauge cannulas. A, A toothed pressure plate is used to displace the conjunctiva and stabilize the globe. The center of the plate is 3.5 mm from the limbus. B, A 45° angled 23-gauge microvitreoretinal blade is inserted in the conjunctiva and sclera at 20° angle, parallel to the limbus. C, Insertion of blunt trocar and cannula through the scleral incision in the center of pressure plate. D, Removal of pressure plate. E, the blunt trocar is removed and a 23-gauge infusion cannula is inserted. F, Introduction of upper nasal cannula with a valve fitting on its port. G, The cannula is fixed with a special forceps and the trocar is removed. H, Twenty three gauge cutter and light probe are inserted in upper ports through the valves. I, One of the Chandelier twin light fiberoptics is inserted through 27- gauge needle puncture into the 23- gauge infusion cannula to create an illuminated infusion cannula for bimanual maneuvers.

Mentions: Each patient underwent a 23-gauge transconjunctival sutureless vitrectomy using the Dutch Ophthalmic Research Center two step-system (DORC, Zuidland, The Netherlands) (Fig 1). The conjunctiva was displaced with a pressure plate with a central opening 3.5 mm from the edge. Angled incisions were made in the conjunctiva and sclera through the pars plana with a 23-gauge 45° angled microvitreoretinal (MVR) blade in the inferotemporal, superonasal, and superotemporal quadrants parallel to the limbus. The blade was inserted at an angle of approximately 20∞ to the sclera, 3.5 mm posterior to the limbus through the central opening of the pressure plate. While keeping the pressure plate in place, the blunt microtrocars were inserted through these wounds and the infusion cannula was placed in the inferotemporal quadrant, while the superonasal and superotemporal cannulas were used for the retinal instrumentation. The Accurus Vitrector (Alcon Laboratories, Inc., Fort Worth, TX) was used for all surgical procedures.


Transconjunctival Sutureless 23-gauge Vitrectomy for Vitreoretinal Diseases: Outcome of 30 Consecutive Cases.

El-Batarny AM - Middle East Afr J Ophthalmol (2008)

Transconjunctival insertion of 23- gauge cannulas. A, A toothed pressure plate is used to displace the conjunctiva and stabilize the globe. The center of the plate is 3.5 mm from the limbus. B, A 45° angled 23-gauge microvitreoretinal blade is inserted in the conjunctiva and sclera at 20° angle, parallel to the limbus. C, Insertion of blunt trocar and cannula through the scleral incision in the center of pressure plate. D, Removal of pressure plate. E, the blunt trocar is removed and a 23-gauge infusion cannula is inserted. F, Introduction of upper nasal cannula with a valve fitting on its port. G, The cannula is fixed with a special forceps and the trocar is removed. H, Twenty three gauge cutter and light probe are inserted in upper ports through the valves. I, One of the Chandelier twin light fiberoptics is inserted through 27- gauge needle puncture into the 23- gauge infusion cannula to create an illuminated infusion cannula for bimanual maneuvers.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3040921&req=5

Figure 0001: Transconjunctival insertion of 23- gauge cannulas. A, A toothed pressure plate is used to displace the conjunctiva and stabilize the globe. The center of the plate is 3.5 mm from the limbus. B, A 45° angled 23-gauge microvitreoretinal blade is inserted in the conjunctiva and sclera at 20° angle, parallel to the limbus. C, Insertion of blunt trocar and cannula through the scleral incision in the center of pressure plate. D, Removal of pressure plate. E, the blunt trocar is removed and a 23-gauge infusion cannula is inserted. F, Introduction of upper nasal cannula with a valve fitting on its port. G, The cannula is fixed with a special forceps and the trocar is removed. H, Twenty three gauge cutter and light probe are inserted in upper ports through the valves. I, One of the Chandelier twin light fiberoptics is inserted through 27- gauge needle puncture into the 23- gauge infusion cannula to create an illuminated infusion cannula for bimanual maneuvers.
Mentions: Each patient underwent a 23-gauge transconjunctival sutureless vitrectomy using the Dutch Ophthalmic Research Center two step-system (DORC, Zuidland, The Netherlands) (Fig 1). The conjunctiva was displaced with a pressure plate with a central opening 3.5 mm from the edge. Angled incisions were made in the conjunctiva and sclera through the pars plana with a 23-gauge 45° angled microvitreoretinal (MVR) blade in the inferotemporal, superonasal, and superotemporal quadrants parallel to the limbus. The blade was inserted at an angle of approximately 20∞ to the sclera, 3.5 mm posterior to the limbus through the central opening of the pressure plate. While keeping the pressure plate in place, the blunt microtrocars were inserted through these wounds and the infusion cannula was placed in the inferotemporal quadrant, while the superonasal and superotemporal cannulas were used for the retinal instrumentation. The Accurus Vitrector (Alcon Laboratories, Inc., Fort Worth, TX) was used for all surgical procedures.

Bottom Line: Main outcome measures included surgical success, visual acuity, intraocular pressure, and operative complications.Subconjunctival silicone oil reported in one eye (3.3%).The safety profile compared favorably with published rates for 25-gauge systems.

View Article: PubMed Central - PubMed

Affiliation: Department of Ophthalmology, Magrabi Eye and Ear Hospital, Muscat, Sultanate of Oman.

ABSTRACT

Background: To describe the initial experience, effectiveness, and safety profile of 23-gauge instrumentation for a variety of vitreoretinal conditions.

Methods: A retrospective review of 30 consecutive 23-gauge vitrectomy cases done by a single vitreoretinal surgeon for various posterior segment conditions was done. All surgeries were performed using the two-step 23-gauge system developed by Dutch Ophthalmic Research Center (DORC). All patients had at least 3-month follow-up. Main outcome measures included surgical success, visual acuity, intraocular pressure, and operative complications.

Results: Mean follow-up was 7.7 months (range 3-12 months). Indications for surgery included rhegmatogenous retinal detachment (n=8), nonclearing vitreous hemorrhage (n=6), tractional retinal detachment (n=5), macular hole (n=5), epiretinal membrane (n=3), retained lens fragments (n=2) and endophthalmitis (n=1). Gas tamponade was used in 18 eyes (60%) and silicone oil in six eyes (20%). Mean overall preoperative visual acuity was 20/1053 and final acuity was 20/78 (P = 0.001). Mean intraocular pressure after 6 hours was 15.1mmHg (range 4-25 mmHg) and on postoperative day one was 14.5 mmHg (range 2-21 mmHg). Four eyes (13.3%) required suturing of sclerotomy intraoperatively. Conversion to 20-gauge was done in one eye (3.3%). Hypotony was reported in one eye (3.3%) postoperatively. Subconjunctival silicone oil reported in one eye (3.3%). There were no postoperative complications of endophthalmitis, retinal or choroidal detachment.

Conclusion: 23-gauge transconjunctival sutureless vitrectomy was effective in the management of wide variety of vitreoretinal surgical indications. The safety profile compared favorably with published rates for 25-gauge systems.

No MeSH data available.


Related in: MedlinePlus