Abstract
Purpose: :
to evaluate the safety and efficacy of 25 gauge vitrectomy for ILM peeling combined with sutureless phaco IOL surgery.
Methods: :
single center prospective interventional case series of 50 eyes operated by one surgeon over a one–year period. All patients underwent surgical procedures using the Open® peristaltic vitrectomy m achine (Corneal France) with a 25 gauge transconjonctival sutureless system (Dorc Neetherland). Pars plana vitrectomy was performed with the flow control set at 4 mL/min and maximum depression set at 500 mmHg, peeling was performed with Dorc 1286W–0,5 forceps looking systematically for the ILM without the use of dye. Subsequently phacoemulsification was realized through clear cornea and a 6,5 mm foldable acrylic lens (MA 50 BM Alcon USA) was inserted into the bag without suturing the 2,8 mm corneal incision. All eyes were assessed pre and post operatively at three months by OCT3 radial lines to evaluate the shape of membrane and retinal thickness. Diabetic, vascular or inflammatory membranes were excluded.
Results: :
mean age was 73 with 38% females. Mean preoperative vision was 27/100 (0,59 LogMAR), mean postoperative vision was 44/100 (0,38 LogMAR ) by three months.Mean macular retinal thickness measured with OCT 3 was 416 µm preoperatively and 332 µm postoperatively. No severe intraoperative complications were noted. One patient required conversion to 20 gauge due to insufficient ocular akinesis and illumination of macula and four others needed conjunctival suture. Mean surgical time was 38 minutes and all eyes were observed for a minimum of 12 weeks. Intra ocular pressures remained stable throughout the postoperative course. We noticed no choroidal detachment and no detectable inflammation. No case of retinal detachment or endophthalmitis was recorded.
Conclusions: :
transconjonctival membrane peeling using 25 gauge instruments combined with sutureless phacoemulsification is a safe and effective alternative in macular surgery. It may hasten postoperative recovery by decreasing surgical time and postoperative inflammation while avoiding a second operation.
Keywords: macula/fovea • vitreoretinal surgery • cataract