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S. Rizzo, F. Genovesi-Ebert, A. Vento, M. Palla, M. Cinquini, L. Allegrini; Ultrahigh Speed 25-g Pars Plana Vitrectomy (PPV) and Aqueous Tamponade in the Treatment of Regmatogenous Retinal Detachment (RRD): Can Technology Development Change Surgical Strategy?. Invest. Ophthalmol. Vis. Sci. 2009;50(13):4204.
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to assess if vitrectomy for repair of RRD performed by using a ultra speed vitrectomy probe, can remove all tractions, thus avoiding the endotamponade with air, gas or silicone oil.
10 consecutive eyes with pseudophakic RRD underwent pars plana vitrectomy (ppv) with Ultra High 5000 cpm cut rate Alcon Constellation® 25-gauge vitrectomy system with duty cycle (dc) control, wide -angle viewing system, injection of perfluoro-n-octane (PFO), endolaser retinopexy and balanced salt solution tamponade (BSS). Follow-up was 14 weeks. Main outcome measure was retinal reattachment under BSS.
At baseline no PVR was evident. Preoperatively 4 eyes had 1 retinal tear (RT), 6 eyes had 2 to 4 RT . Intraoperatively 27 RT (6 missed) were identified by scleral indentation and xenon chandelier light. DC is the percent of time during which the vitrectomy port remains open thus allowing aspiration. VPP was performed with maximum dc profile in core mode during central vitrectomy and minimum dc profile in shave mode near the retina, using Triesence® as vitreous highlighter. The new cutter was able to safely work very close to the retina without hurting or pulling it. After injecting PFO till the posterior edge of RT, drainage of subretinal fluid was performed using the cutter with active aspiration during BSS/air exchange. Endolaser was carried out on RT with Purepoint® 532 nm probe. PFO was aspired and finally air/BSS exchange was performed. In all eyes the retina remained attached with BSS filling therefore the surgery was ended. Mean total ppv time was 23 minutes. No intraoperative complications related to ultra high speed were displayed, no intraoperative RT occurred. At the final follow-up all eyes were still attached.
Due to technology development such as ultrahigh cut rate and dc control the UHS vitrector allowed a quick and efficient core vitrectomy and a complete and safe shaving of the vitreous basis. All tractions could be completely removed thus allowing the complete fluid drainage, and a sufficient intraoperative chorioretinal retinal adhesion after endolaser retinopexy. Therefore in uncomplicated RRD, we were able to avoid any nonaqueous tamponade by using a mini invasive system .
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