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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)
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.
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.
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.
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.
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