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Nancy M. Buchser, Jeremy B. Wingard, Kimberly V. Miller, Robert J. Noecker; 25 Gauge Microsurgical Forceps and Fibrin Glue Expedite Glaucoma Drainage Device Surgery. Invest. Ophthalmol. Vis. Sci. 2011;52(14):2641.
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To decrease risk of prolonged operative time and surgical costs in glaucoma drainage device surgery. We report a new technique using 25 gauge (25G) microsurgical forceps and fibrin glue to achieve faster surgical time as compared to standard methods.
Twenty-four videos of glaucoma drainage device (GDD) surgery were retrospectively reviewed. Sixteen used standard toothless Hoskins forceps and eight used 25G microsurgical forceps (Dutch ophthalmic research center [D.O.R.C] forceps) to insert the GDD tube. Timing of various stages included: first incision, placement of glaucoma drainage device plate, trimming of tube, grasping of tube with surgical instrument (either 25G microsurgical or toothless Hoskins forceps), releasing of tube after insertion into the eye, suturing tube to sclera, conjunctival closure (with fibrin glue [n=22] or suture [n=2]), and total case time. Duration of surgical steps was compared between the surgical techniques and significance was determined.
Average total time for GDD surgery using 25G microsurgical forceps was 16.0 +/- 4.8 minutes, and using standard forceps was 22.4 +/- 8.0 minutes. The use of 25G microsurgical forceps shortened total case time by 28.3%, p= 0.032. Half of this difference in case duration is explained by the use of 25G microsurgical forceps. Average time for insertion of GDD tube using 25G microsurgical forceps was 0.6 +/- 0.3 minutes, and using standard forceps was 3.2 +/- 2.3 minutes. The use of 25G microsurgical forceps shortened time of tube insertion by 80.1%, p= 0.002.
25G microsurgical forceps and fibrin glue shorten GDD surgical time. As healthcare spending is increasingly scrutinized, efforts to improve surgical efficiency will help reduce overall medical costs.
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