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L.J. Rao, M. Ward, F. Seffo, K. Jamal, S. Huang; Complications of 25–Gauge Vitrectomy Surgery in a Preliminary Series: A Comparative Analysis of the Learning Curve Effect . Invest. Ophthalmol. Vis. Sci. 2006;47(13):4663.
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Recent studies have examined the experiences of multiple surgeons utilizing 25–gauge vitrectomy to treat an assortment of vitreoretinal diseases. We examined the complications encountered during an initial surgical case series of this relatively new procedure, and investigated whether the presence of a learning curve effect influenced outcomes.
A literature review of published and unpublished case series was performed to evaluate the incidence of post–operative complications following intraocular surgery. We reviewed the first 98 cases of a single author, SH, to evaluate the incidence of post–operative complications.
98 eyes underwent surgery for epiretinal membrane (13), non–clearing vitreous hemorrhage (52), CRVO (5), vitreous opacities (8), ROP (1), endophthalmitis (2), BRVO (1), BRAO (1), traction retinal detachment (9), and rhegmatogenous retinal detachment (6). The incidence of endophthalmitis (0/98), hypotony (9/98), choroidal elevation (0/98), retinal detachment (4/98), elevated intraocular pressure (18/98), and persistent vitreous hemorrhage (3/98) were assessed. Hypotony (<5mmHg) was found to be transient. The issue of elevated postoperative intraocular pressure requiring medication resolved in all cases encountered.
The concept of a surgical learning curve is well established in intraocular surgery. Various studies have demonstrated a decrease in the number of complications as surgeons repeatedly perform procedures. As a trend towards increased utilization of 25–gauge vitrectomy has been identified, new as well as experienced surgeons are implementing this procedure and thus beginning the learning curve process. This series consisted of the early phase of this new procedure, and thus the beginning of the surgical learning curve. The complication rates were found to be comparable to 20–gauge technique. This finding implies that the surgical learning curve of 25–gauge vitrectomy is short, and as ophthalmologists progress along this curve, it is possible that lower complication rates could exist.
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