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J.P. Denny, G.B. Hubbard, III; Pars Plana Vitrectomy Using a 25–Gauge System in Patients with Proliferative Diabetic Retinopathy . Invest. Ophthalmol. Vis. Sci. 2006;47(13):4640.
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Pars plana vitrectomy (PPV) is commonly performed to treat the ocular complications of proliferative diabetic retinopathy (PDR). Recently, 25–gauge systems for PPV have been reported to decrease post–operative recovery time. The purpose of this study is to investigate the safety and efficacy of PPV performed via a 25–gauge trocar system in a group of patients with proliferative diabetic retinopathy.
All charts of a consecutive series of patients undergoing PPV using a 25–gauge system by a single surgeon (GBH) were retrospectively reviewed. Patients with less than 1 month of follow–up were excluded.
9 eyes of 9 patients were identified. Mean age was 52 years (range 43–59). Mean follow–up was 16 weeks (range 9–26). In addition to PDR, 5 eyes carried the diagnosis of vitreous hemorrhage, 4 eyes carried the diagnosis of traction retinal detachment, 3 eyes carried the diagnosis of epiretinal membrane and 1 eye carried the diagnosis of macular edema. All eyes underwent PPV with membrane stripping. Additionally, 4 eyes underwent endolaser photocoagulation, 4 eyes underwent fluid–air exchange and the eye with macular edema had injection of intravitreal triamcinolone acetonide (4mg in 0.1cc). One sclerotomy required enlargement for 20–gauge instrumentation. If fibrovascular tissue was adherent to the retina, viscodissection was performed via the 25–gauge trocar using viscoelastic on a cannula attached to the automated viscous fluid injector of the vitrectomy machine. Visual acuity improved in 6 eyes, remained stable in 2 eyes and worsened in 1 eye. There was recurrent vitreous hemorrhage in 2 eyes, both of which cleared without further surgery. One eye had persistent elevated intraocular pressure requiring 2 topical medications for control. No other complications were noted.
Although this group of patients is small, PPV using a 25–gauge system appears to be safe and efficacious in the treatment of ocular complications of PDR. To our knowledge, viscodissection via a 25–gauge trocar has not been reported. In our experience, this viscodissection technique was particularly useful in cases of adherent membranes that would have otherwise required converting at least 1 sclerotomy to 20–gauge.
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