25-gauge vitrectomy feasible for the pediatric setting

Br J Ophthalmol. 2009;93(6):787-790.

Transconjunctival 25-gauge vitrectomy is feasible in pediatric eyes, although modification of the technique may be appropriate for children younger than 1 year.

A retrospective review of 56 eyes of 49 consecutive children younger than 18 years undergoing 25-gauge vitrectomy found few surgically related complications: conversion to 20-gauge vitrectomy (four eyes), conversion of one port to a 20-gauge sclerotomy (one), suspected lens damage (one) and intraoperative bleeding from a vascular ridge (one).

Postoperatively, five eyes developed a cataract, and four developed a rhegmatogenous retinal detachment, but the retinal detachments were not believed to be related to the surgical technique, the study authors said. Three eyes had postoperative vitreous hemorrhage. Additionally, there were no cases of postoperative hypotony, despite the theoretical increased risk of eye rubbing in pediatric patients. There was no postoperative endophthalmitis or choroidal detachment.

Two distinct surgical techniques were analyzed in the study. In children between 1 year of age and 18 years of age, a standard transconjunctival 25-gauge approach was used. In patients younger than 1 year, the sclerotomy incisions were made through the pars plicata, and the sclerotomies and conjunctiva were sutured.