Vitrectomy Using Continuous Infusion of Oxygenated (ViCIOP ) and Non-oxygenated Perfluorocarbons (ViCIP). A New Technique for Vitrectomy

Abstract

Abstract: : Purpose: To asses the safety and eficcacy of a new vitrectomy technique in which balanced saline solution was replaced by oxygenated and non-oxygenated perfluorocarbons liquids (PFCLs). Methods: A prospective, experimental non comparative and longitudinal, study was conducted. The study was divided in two phases, the first one using animal models included twelve rabbit eyes and two porcine eyes. A second phase was carried out in human eyes including twenty eyes of twenty patients. In both phases ViCIOP and ViCIP were performed using a recycled or a non-recycled system. Clinical evaluation, electroretinogram (ERG), and endothelial cell count (ECC) were determined and registered in all eyes as well as histophatologic study in animal eyes. An arbitrary grading scale (ranged 0 to 5) was designed in order to evaluate and qualify the eficcacy of each procedure. Parameters evaluated included: visibility in the vitreous cavity during surgery, rapid retinal reattachment, bleeding from new vessels, identification of intraocular structures, retinal stability during vitrectomy, presence of retinal detachment in accidental retinotomies, preclude of steps during surgery, facilitation of surgical maneuvers, and time of surgery. Results: ViCIOP or ViCIP performed in rabbit, pig, or human eyes, showed that when collecting products aspirated by vitrectomy probe using a syringe or a plastic bag, nice separation of the vitreous, debris, and blood was possible, in a manner analogous to chromatography. Intraoperative use of perfluorocarbon effectively facilitated vitreous and intraocular structures identification. Surgical maneuvers such as peeling, delamination, or segmentation were performed under exceptionally good viewing conditions and a substantial reduction of surgical was possible due to less bleeding, rapid retinal flattening and preclude of several surgical steps. No significant changes in the ERG or endothelial cell count were observed. Eighteen patients were graded with 5 and the two remaing with 4. Conclusions: ViCIOP and ViCIP using a recycled or a non-recycled system is a safe and feasible technique that increases efficacy of the procedure by facilitating surgical maneuvers and allowing preclude of surgical steps. Further research is necessary

Keywords: vitreous substitutes • vitreoretinal surgery • vitreous