June 2013
Volume 54, Issue 15
Free
ARVO Annual Meeting Abstract  |   June 2013
27-gauge sutureless microincision vitrectomy surgery for various retinal pathologies
Author Affiliations & Notes
  • Stanislao Rizzo
    UO Chirurgia Oftalmica, Azienda Ospedaliero-Univ Pisana, Pisa, Italy
  • Federica Genovesi-Ebert
    UO Chirurgia Oftalmica, Azienda Ospedaliero-Univ Pisana, Pisa, Italy
  • Francesco Barca
    UO Chirurgia Oftalmica, Azienda Ospedaliero-Univ Pisana, Pisa, Italy
  • Emanuele Di Bartolo
    UO Chirurgia Oftalmica, Azienda Ospedaliero-Univ Pisana, Pisa, Italy
  • Footnotes
    Commercial Relationships Stanislao Rizzo, None; Federica Genovesi-Ebert, None; Francesco Barca, None; Emanuele Di Bartolo, None
  • Footnotes
    Support None
Investigative Ophthalmology & Visual Science June 2013, Vol.54, 5794. doi:
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      Stanislao Rizzo, Federica Genovesi-Ebert, Francesco Barca, Emanuele Di Bartolo; 27-gauge sutureless microincision vitrectomy surgery for various retinal pathologies. Invest. Ophthalmol. Vis. Sci. 2013;54(15):5794.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose: To evaluate the efficiency, preliminary safety, and feasibility of a 27-gauge instrument system for transconjunctival microincision vitrectomy surgery (MIVS) in a variety of vitreoretinal diseases.

Methods: Interventional case series twenty-one eyes (21 patients) underwent a variety of vitreoretinal procedures using the 27-gauge transconjunctival MIVS Alcon CONSTELLATION®system to treat epiretinal membrane (n = 7), idiopathic macular holes (n = 5), diabetic vitreous hemorrhage (n = 3), vitreous opacity (n = 3), focal diabetic traction retinal detachment (n = 2), macular traction syndrome (n = 1). Surgical outcomes, including anatomic success, visual outcomes, operating times, and intraoperative and postoperative complications, were evaluated. Main outcome measure was the sclerotomy closure.

Results: Anatomic success was achieved in all study eyes (100%); 17 eyes (80%) had visual improvement of 3 lines or more. No eyes required conversion to larger gauge instrument. All sclerotomies self-sealed without hypotony (IOP < or = 7 mmHg) from 1 day postoperatively. No sutures was required. Mean operative times was 36,3 minutes (range 24,5-91,4 minutes). No surgical related complication occurred.

Conclusions: The most serious criticisms regarding the current 23- and 25-g systems have focused on complications related to wound sealing, such as leakage, hypotony, and postoperative infectious endophthalmitis. Although the recent refinement of trocar-cannula systems has ergonomically improved their self-sealing architectures, special techniques are still required. Complete self-sealing wounds are not yet achievable in every case, even with 25-g systems. Indeed by using the 27-g system , opening and closing procedures are simplified compared to 23- and 25-g systems. Although the fluid dynamics and cutting efficiency of 27-gauge instruments are lower compared with 25-gauge MIVS, the 27-gauge system is feasible and may reduce concerns about wound sealing-related complications in selected cases.

Keywords: 762 vitreoretinal surgery • 688 retina • 763 vitreous  
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