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Transconjunctival microincision vitrectomy with 27-gauge cutter proves safe, effective

Issue: June 2010

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A unique 27-gauge instrument system for transconjunctival sutureless microincision vitrectomy surgery was shown to be safe and effective for multiple indications, according to a study.

Yosuke Oshima

“The most remarkable finding in 27-gauge vitrectomy is that no eyes in our series developed wound-sealing complications such as conjunctival air bubbles, conjunctival swelling or hypotony … suggesting favorable self-sealing structures for the 27-gauge scleral wounds,” Yosuke Oshima, MD, and colleagues said.

The instrument array included an infusion line, high-speed vitreous cutter, illumination system, membrane forceps and other vitreoretinal components. The vitreous cutter had a 25-mm shaft to enhance rigidity.

The 27-gauge cutter compared favorably with a 25-gauge cutter in fluid aspiration and cutting tests with balanced salt solution and porcine vitreous samples.

The pilot clinical study included 31 eyes of 31 patients with a mean age of 62.9 years and mean axial length of 24.7 mm. Indications were epiretinal membrane, idiopathic macular hole, diabetic vitreous hemorrhage, vitreous opacity with suspected intraocular lymphoma, focal diabetic traction retinal detachment, macular traction syndrome and macular edema secondary to central retinal vein occlusion.

All eyes underwent surgery with 27-gauge instrumentation. Mean operating time was 34.3 minutes; the mean postoperative follow-up interval was 6.9 months.

Study data showed that all 27-gauge sclerotomies self-sealed without hypotony. Anatomic success was achieved in all eyes. Mean IOP did not change significantly after surgery.

Mean logMAR visual acuity improved from 0.17 before surgery to 0.62 at final follow-up; visual acuity improved by three lines or more in 20 eyes (65%).

Vitreous hemorrhage recurred in two eyes but resolved without surgical intervention. No other postoperative complications occurred, the authors said. – by Matt Hasson

Reference:

• Oshima Y, Wakabayashi T, Sato T, Ohji M, Tano Y. A 27-gauge instrument system for transconjunctival sutureless microincision vitrectomy surgery. Ophthalmology. 2010;117(1):93-102.