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V.L. Morrison, I. Falkenstein, A.M. Tammewar, W.R. Freeman; Evaluation of Hypotony and Other Complications of the 25–Gauge Sutureless Vitrectomy System . Invest. Ophthalmol. Vis. Sci. 2006;47(13):4659.
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To evaluate the 25–gauge Transconjunctival Sutureless Vitrectomy (TSV) system focusing on complications associated with instrumentation (e.g. rate of wound leak or retinal detachment (RD)). The system used included a solid trocar designed to avoid tearing the sclera or removing tissue. We also describe a technique of clamping the sclera with forceps as the cannula is removed at the end of the case to help seal the wound.
Retrospective, consecutive chart review of one surgeon’s (WRF) 50 patients that underwent vitrectomy with the 25–gauge Accurus TSV for macular disease or media opacity. At the end of the case when removing the cannulas we immediately clamped the sclera with forceps. We determined the incidence of post–operative complications.
Mean follow–up was 147 days. There was one post operative case of hypotony manifest by a mild choroidal effusion and conjunctival bleb which resolved spontaneously. The incidence of wound leak, bleb formation, retinal detachment and the need to return to the operating room for re–suturing was zero.
This is the largest series describing the results of the Accurus 25–gauge TSV system. We report a low rate (2%) of post–operative hypotony. Other systems have reported the rate to be as high as 3.8% for choroidal detachments and a 7.1 % rate of bleb formation requiring additional suture placement.i We believe the difference in wound leak could be accounted by the difference of the entry trocar between the two systems. The initial 25–gauge vitrectomy systems employed a trocar in the form of a needle with a hollow center (photo 1). The system we evaluated uses a solid trocar (photo 2). Also we describe a technique of clamping the sclera as the cannula is removed at the end of the case to induce scleral edema and help tighten the closure of the sclerotomy. i Ibarra MS, Hermel M, Prenner J, et. al. Longer–term Outcomes of Transconjunctival Sutureless 25–gauge Vitrectomy. Ophthalmology 2005; 139:831–836. ii Fujii GY, de Juan E, Humayun MS, et. al. A New 25–gauge Instrument System for Transconjunctival Sutureless Vitrectomy Surgery. Ophthalmol 2002; 109: 1807–1812.
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