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N.J. Rudometkin, E.L. Thomas, K.A. Hunter; Case Selection, Complications, and Visual Recovery During the Initial Sixty–Two Cases Using 25–Gauge Vitrectomy . Invest. Ophthalmol. Vis. Sci. 2005;46(13):5460.
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© ARVO (1962-2015); The Authors (2016-present)
Purpose: To discuss the case selection, complications, visual recovery during the 62 cases of a single surgeon using 25–gauge vitrectomy. Methods: A retrospective review of the initial 62 vitrectomies using Alcon 25–gauge vitrectomy system by a single surgeon over a 5 month period was performed. Main outcome variables included complication rates and time to recovery of visual acuity. Results: Case selection for 25 gauge surgery was on the basis of feasibility in accomplishing surgical objectives with smaller instrumentation, reduced accessory instruments, and reduced illumination. Sixty–two eyes underwent surgery for vitreous hemorrhage (23), epiretinal membrane removal (16), macular hole (6), retinal detachment (6), retained lens material and vitreous opacities (6), vitreomacular traction (2), endophthalmitis (2) and sheathotomy for branched retinal vein occlusion (1). Complications included subconjunctival gas (2), air/gas in anterior chamber (4) causing anterior subcapsular cataract in (2), retinal detachment (3), vitrector breakage (2) and iris prolapse through clear corneal incision (2). No wound leaks, endophthalmitis or chronic hypotony requiring subsequent intervention were encountered. Conversion to 20–gauge instrumentation was required in three eyes and five eyes required closure of sclerotomies intraoperatively. Mean time to recovery of final visual acuity showed a trend towards shorter recovery. Patient discomfort, external ocular irritation and conjunctival ecchymosis and chemosis were significantly reduced. Conclusions: Over the last two years the American Society of Retinal Specialists in the PATS survey found the percentage of those regularly using 25–gauge vitrectomy has doubled (6% vs. 13%) and over two thirds have tried 25–gauge systems. Despite the increase in use, little documentation regarding the occurrence of complications exists. Unique complications including anterior chamber air causing subcapsular cataract and vitrector breakage. Wound dehiscence of clear corneal incisions in endophthalmitis cases leads to the recommendation that clear corneal incisions should be sutured. An unexpectedly high rate of retinal detachment was found in 3/6 cases of vitrectomy for macular hole. All three detachments were found with breaks in the mid–periphery around areas of persistent vitreous attachment. Overall, a trend toward shorter visual recovery was found with complication rates acceptably low and that will likely decrease further given greater experience using the 25–gauge system.
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