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Ricardo Valdes, Oscar Leonel Ramirez, Francisco Ochoa, Jose Fernando Trujillo; Primary Repair of Rhegmatogenous Retinal Detachment with 23-Gauge Transconjonctival Vitrectomy. Invest. Ophthalmol. Vis. Sci. 2012;53(14):5784.
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To comunicate a retrospective case series of reghmatogenouos retinal detachment that underwent transconjonctival vitrectomy repair with 23-Gauge. Primary endpoint was to assess the rate of success reattachment with the primary surgery, gain in visual acuity and complications related to the technique. Postoperative follow-up ranged from 3 to 6 months.
Primary vitrectomy with 23-gauge was perfomed in sixteen eyes of sixteen patients. There were phakic as well as pseudophakic patients with ages between 25 and 68 years. Brakes location was documented before and during the surgery. All procedures were carried out by the same vitreoretinal surgeon as follows: placement of three ports with 23-Gauge trocars system of Alcon followed by vitrectomy with the Accurus Alcon system. Endolight provided by the Synergetics Photon TM and wide angle visualisation with the LPW lens of Ocular Systems. Use of perfluorocarbon liquid to flatten the retina followed by cryo or endolaser application; then aspiration of subretinal fluid through the brake or through a posterior retinotomy. Finally, exchange liquid-air and air-gas or silicon.
Retina was flattened in thirteen eyes (81.25%)with the primary surgery. Two eyes needed a second intervention and one a thirth procedure. Significant visual acuity improuvement was noticed in the vast majority. The most important complications observed were cataract, choroidal detachment and transient hypotony. Two patients developed proliferative vitreoretinopathy and were reoperated once more with total reattachment under silicone. Finally one redetachment due to new peripheral brakes was submitted to two more procedures, gas and then silicon injection to complete the flattening of the retina.
Transconjonctival vitrectomy with 23-Gauge to repair retinal detachement shows similar rates outcomes as those obtained with 20-Gauge vitrectomy with or without encircling band as indicated in numerous studies. Nevertheless the evident advantages of this technique as patient comfort, less inflammation, less postoperative pain, decrease in surgery time and faster rehabilitation explain clearly the actual shift in this direction.
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