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G. C. Chang, S. Kiss, C. Andreoli, D. Vavvas; Intraocular Foreign Body Removal Using 25-Gauge Vitrectomy Results in Excellent Anatomic and Visual Outcomes. Invest. Ophthalmol. Vis. Sci. 2008;49(13):4662.
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With continued evolution of modern pars plana vitrectomy (PPV), cases traditionally performed using 20-gauge instrumentation are now often done with sutureless 25-gauge systems. The sutureless techniques permit smaller wounds that may allow for faster recovery and may avoid the discomfort associated with conjunctival/scleral sutures. The additional advantage of the 25-gauge handpiece is the improved fluidics at the vitrectomy port that produces less vitreous chatter. This allows for cutting closer to mobile tissues while minimizing retinal incarceration and movement of objects embedded within the vitreous. We present 3 cases of intraocular foreign bodies (IOFB) removed using 25-gauge PPV.
Interventional case series.
3 cases of ruptured globe (RG) with IOFBs underwent 25-gauge PPV. The first case was a 32-year-old male with a thin, oblong IOFB that penetrated the cornea and iris and ended up near the fovea. The lens was completely spared. The preoperative visual acuity (VA) was counting fingers. The corneal laceration was repaired with a 10-0 nylon suture. 25-gauge lens-sparing PPV was used to remove the vitreous surrounding the IOFB. One sclerotomy site was enlarged and IOFB forceps were used to remove the object. Post-operative VA was 20/40. The second case involved a 25-year-old female in car accident. An IOFB penetrated the superior limbus. The preoperative VA was light perception. A 25-gauge PPV and lensectomy was performed after closure of the scleral laceration. Post-operative VA was 20/25. The third case involved a child who had a RG repaired following a dart injury. The IOFBs were not recognized at the time of initial repair. With the clearing of the vitreous hemorrhage, 2 long, thin IOFBs were noted to be sitting on the macula. A 25-gauge sutureless PPV was used to remove the IOFBs through the 25-gauge sclerotomies without the need for enlargement. In all cases, the IOFBs were on the macula and were removed without any additional damage to the retina.
25-gauge PPV is practical and reasonable alternative in cases of IOFB removal. The unique fluidics of the 25-gauge vitrector allow for the complete removal of vitreous while minimizing the movement of the IOFB. The visual outcomes achieved in these cases may not have been possible if the foreign bodies were moving around, striking the fovea and damaging the retina.
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