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L. P. Chong, J. B. Ramos, L. Lima; Improving Success of 25 Gauge Vitrectomy Repair of Retinal Detachment: A Retrospective Review of 49 Consecutive Cases. Invest. Ophthalmol. Vis. Sci. 2008;49(13):4053. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
To demonstrate that changes in technique were necessary to improve outcomes in 25 gauge vitrectomy repair of primary rhegmatogenous retinal detachment.
Retrospective review of patients undergoing 25 gauge vitrectomy repair of primary rhegmatogenous retinal detachment performed by a single surgeon using a contact panoramic viewing system. Assisted or bimanual scleral depression of the vitreous base and aggressive vitreous base shaving was performed in all cases. Primary outcome measure was complete retinal reattachment achieved with a single operation.
Forty-nine consecutive eyes were operated between 12/17/03 and 11/16/07. Mean followup was 51 weeks. Twenty eyes were operated between 12/17/03 and 9/28/04 ("Early Time Period) . Twenty-nine eyes were operated between 1/9/05 and 11/16/07 (Later Time Period). In the early time period air was often used (42.1%), sclerotomy suture closure was less frequent (45%), and endolaser was delivered in spot fashion. In the later time period, air was no longer used, canulas were inserted in a bevelled fashion, sclerotomy suture closure was more often (70%), laser was delivered in a continuous mode, and there was increased use of illuminated chandelier infusion canula. Complete retinal reattachment was achieved after a single operation in 30% of eyes in the early time period and in 72.4% of eyes in the later time period. Ten of the last 10 consecutive retinal detachments were repaired successfully suggesting further improvement of technique.
Leaking sclerotomies which result in poor gas fill, flexibility of instruments which prevent adequate view of the peripheral retina, and laser probes which deliver an inadequate spot size can contribute to poorer anatomic outcomes after 25 gauge vitrectomy. Bevelled incisions reduce leakage of gas and leaking sclerotomies can be closed with a small temporary transconjunctival suture. The lluminated chandelier canula improves inspection of the peripheral retina and permits bimanual shaving of the vitreous base. Painting the borders of retinal tears with laser improves retinopexy. Twenty-five gauge vitrectomy repair of primary rhegmatogenous retinal detachment is more difficult and must be performed differently from 20 gauge vitrectomy to achieve satisfactory results. However, I prefer 25 gauge vitrectomy because of excellent fluidics (vitrectomy close to detached retina is safer) , decreased infusion volume and superior post-operative comfort and visual recovery.
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