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GY Fujii, E de Juan Jr, MS Humayun, TS Chang, A Barnes; 25 Gauge TransconjunctivalSutureless Vitrectomy (TSV) System: Initial Clinical Experience . Invest. Ophthalmol. Vis. Sci. 2002;43(13):3537.
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Purpose: To introduce, evaluate the infusion and aspiration rates, and describe the initial experience of the 25-gauge transconjunctival sutureless vitrectomy system (TSV). Methods: Design: In vitro experimental and review of a consecutive interventional case series. Infusion and aspiration rates of the 25-gauge and standard 20-gauge vitrectomy system were measured in vitro using balanced saline solution and porcine vitreous for several levels of aspirating power and bottle height. Participants: Thirty-five eyes of thirty-three patients, including cases of idiopathic epiretinal membrane (12 cases), retinal detachment (6 cases), macular hole (5 cases), branch retinal vein occlusion (4 cases), retinopathy of prematurity (4 cases), persistent diabetic macular edema (1 case), diabetic vitreous hemorrhage (1 case), retained lens material after cataract extraction (1), Norrie disease (1 case). Intervention: All patients underwent surgery using the TSV system. Main Outcome Measures: infusion, aspiration rates of the 20-gauge and 25-gauge vitrectomy system; early and late postoperative intraocular pressure; postoperative visual acuity; and occurrence of complications. Results: The average flow rate of the Storz 25 gauge cutter (at 500 mmHg, 1500 CPM) was 40% greater than that of the 20 gauge pneumatic cutter (at 250 mmHg, 750 CPM), but about 2.3 times lower then the 20 gauge high speed cutter (at 250 mmHg, 1500 CPM). All surgical procedures were effectively performed using the TSV. The median preoperative intraocular pressure was 16 mmHg (range, 10 to 21 mmHg) while the median intraocular pressure of the first postoperative day was 12 mmHg (range, 6 to 28 mmHg). The median intraocular pressure at 1 week and 1 month were both 16 mmHg (range, 10 to 30 mmHg). Overall, the median preoperative visual acuity was 20/100 (range, 20/30 to hand motions) and the median postoperative visual acuity after a mean follow-up of 14 weeks (range, 1 to 60 weeks) was 20/60 (range, 20/20 to 20/150). One eye developed a postoperative retinal detachment. Conclusion: The 25-gauge TSV appears to be practical and safe for a variety of vitreoretinal procedures. The concept of transconjunctival and minimally invasive surgery has the potential to increase efficiency of a variety of vitreo-retinal surgeries and possibly hasten the postoperative recovery and outcomes in several conditions by simplifying the surgical procedure, minimizing surgically induced trauma, decreasing the convalescence period, the operating time and the postoperative inflammatory response.
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