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B. L. Davis, D. S. Dyer; Vitrectomy Time and Fluid Dynamics in 23 Gauge and 25 Gauge Micro-Incision Vitrectomy Surgery. Invest. Ophthalmol. Vis. Sci. 2007;48(13):2245.
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Evaluate the surgical time to complete a vitrectomy using the 23 gauge and 25 gauge Alcon Accurus® vitrectomy systems and to evaluate the amount of fluid infused into the eye.
Data from 23 gauge and 25 gauge (g) were collected prospectively in a series of patients from February 2006 through November 2006. Using the timer on the Alcon Accurus® system the time was measured for vitrectomies using 1200 and 1500 cuts per minute (CPM) in the 25g system. In the 23g system the vitrectomies were done in the 3D mode with starting cut rate at 2500 CPM decreasing to 2200 CPM using full treadle. The infusion bottle was weighed before and after each surgery to calculate the volume that was infused into the eye. The volume used was adjusted to compensate for the volume of fluid remaining in the infusion line.
The average vitrectomy time for all 45 cases done with the 25g system was seven minutes and fifty six seconds. The range was from 3:00 to 12:05 minutes. When broken down into 1500 and 1200 CPM the times were 7:21 (n = 25) and 8:39 minutes (n = 20) respectively. The average vitrectomy time for the seven 23g cases was 7:58 minutes with a range of 6:57 to 14:01 minutes. These times were determined using the 2500 CPM setting. Evaluation of the volume of balanced salt solution that was infused into the eye for the 25g surgery was 45.91 ml for the 14 cases that had the volume recorded. When breaking the volumes down by cuts per minute when using the 1500 CPM setting the average volume infused was 50.65 ml (n = 9) and for the 1200 CPM setting the average was 37.38 ml (n = 5). For the 23g surgery there were seven cases that had the infusion volume recorded, and it was found that the average amount of infusion was 103.67 ml.
Using the Alcon Accurus® microsurgical vitrectomy system the average case time is less than eight minutes for both the 23g and 25g vitrectomy systems. The average infusion volume for the 25g system is less than half of what is used in the 23g system. With further evaluation the volume of fluid used, higher cut rate, and time of vitrectomy could have a significant effect on post operative recovery time. Additionally, with less fluid circulating through the eye, the operative environment is likely more stable lending to a technically easier surgery and less stress to the intraocular environment.
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