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E. Rapizzi, F. Giansanti, L. Vannozzi, V. Borgioli, G. Razzoli, M. Scrivanti, U. Menchini; Two–Port 25–Gauge Sutureless Transcongiuntival Vitrectomy for Macular Surgery: New Approach . Invest. Ophthalmol. Vis. Sci. 2006;47(13):3245.
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To evaluate the feasibility of two–port 25–gauge sutureless transcongiuntival vitrectomy in patients affected by macular pucker and macular hole.
The surgery was based on two–port–pars plana vitrectomy using 25 gauge instruments. A microscope slit–lamp light source and a disposable flat vitrectomy contact lens have been used to visualize the fundus during vitrectomy. The main steps of the surgical procedure were as follow: two pars plana port were performed respectively at 11 o’ clock meridian for right–handed surgeon and in the infero–temporal quadrant of the eye. Core vitrectomy was performed and the posterior hyaloidal vitreous was detached with 25–gauge vitrectomy probe. After ICG (0.125%) staining, the internal–limiting membrane was peeled by intraocular forceps. Ten consecutive patients with macular pucker (n.6) and full–thickness macular hole (n.4) were treated. If significant cataract was present before surgery a combined phacoemulsification was performed at the time of vitreoretinal surgery. The IOL was implanted in the bag at the end of the vitrectomy procedure before air–fluid exchange in patients affected by macular hole. A complete ocular examination was performed at baseline and at each follow–up visits. OCT was performed at baseline and after 1, 3 and 6 months.
The surgical procedure was successfully completed in all patients. In our limited case series was not necessary to move at 20–gauge technique. In all cases the microscope slit–lamp light source system was effective. No major complications, such as retinal tears and retinal detachment, were detected intraoperatively or during post–operative follow–up visits (mean follow up 6 months). A slight leakage of air from the sclerotomies was detected in two patients at the end of macular hole surgery. No sclerotomies sutures have been placed in all patients. No clinical significant hypotony was detected 1 day after surgery. OCT showed a significant reduction of macular edema after surgery in patients affected by macular pucker. OCT revealed a complete closure of macular hole in three patients and showed flattened edges without closure in one.
Considering the limited series, the functional results will be analyzed singularly.
This procedure allows performing macular vitreoretinal surgery minimizing surgical ocular trauma and reducing patient post–operative discomfort. Slit lamp illumination may reduce a phototraumatic macular damage. The expected difficulties during the surgical technique, correlated to the instrumentation flexibility, were not detected.
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