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S. Rizzo, F. Genovesi-Ebert, A. Vento, M. Palla, F. Cresti, S. Miniaci, L. Allegrini; A New "Single Step Entry" System for 23-Gauge Vitrectomy. Invest. Ophthalmol. Vis. Sci. 2007;48(13):2217.
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© ARVO (1962-2015); The Authors (2016-present)
23 gauge transconjunctival pars plana vitrectomy (ppv) incision is currently performed with a two step procedure entering the vitreous chamber with a stiletto blade and then inserting the cannula-trocar system. Recently a new 23-g System has been developed by Alcon, in order to allow a simplified single-step entry. Aim of this study was to evaluate the efficacy of this new instrument.
12 eyes of 12 consecutive patients were treated from june to september 2006. Diagnoses included proliferative diabetic rethinopathy (n 2 ), epiretinal membrane (n 3 ), macular hole (n 5), retinal detachment with PVR (n 2).The Alcon 23-g system has been designed like the 25-g ones with the blade and the titanium cannula all together. The system was inserted with an oblique angle of 30°. Cutter had 2500 CPM cut rate, and port location was moved 50% closer to the tip than 20-g probe. The procedure was combined with phacoemulsification in 5 eyes, in 2 silicone oil endotamponade was required.
The new 23-g system was easy to insert due to the sharp trocar blade design. Silicone oil was instilled through the cannula without enlarging sclerotomy. The stiffness of the tools allowed a good control. High speed cutter allowed a safe fluidics, and the port location allowed peripheral vitreous shaving and membranes dissection very close to the retina, without using scissors. The mean operation time was 29 minutes. The oblique wound construction self-sealed immediately. No intra and postoperative complications were encountered, no hypotony occurred. Neither wound leakage nor infection was identified.
Using the system introduced here, 23-g the trocar-cannula system insertion was performed with a single manoeuvre. 23-g probe achieved a safe fluidics due to the high-speed cut and to the small port. Moreover the port location near the distal end, avoided the use of curve scissors, difficult to introduce through the cannulas, thus reducing the number of tools exchange. The surgery was quick, easy and safe, and allow us to espand the indications eligible for microincision surgery.
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