Silicone oil tamponade in 23-gauge transconjunctival sutureless vitrectomy.
ABSTRACT To describe 20 consecutive patients treated with 23-gauge transconjunctival sutureless vitrectomy and silicone oil tamponade for retinal detachments (RD) of different etiologies.
Prospective case series. Twenty patients with complex retinal detachment were submitted to a primary 23-gauge transconjunctival pars plana vitrectomy: rhegmatogenous retinal detachment with proliferative vitreoretinopathy (RRD + PVR) in 7 cases, diabetic tractional retinal detachment (DTRD) in 5 cases, giant retinal tear (GRT) in 2 cases, RRD with multiple tears in 2 cases, GRT + uveitis in 1 case, RRD + uveitis in 1 case, DTRD + RRD in 1 case, and RRD + PVR with intraocular foreign body (IOFB) in 1 case. Length of postoperative follow up ranged from 3 to 14 months.
Final visual acuity ranged from 20/25 to hand motion. Postoperatively, none of the 20 eyes had hypotony or leakage of silicone oil through the sclerotomies. Seventeen out of 20 (85%) had improved vision.
Silicone oil tamponade was demonstrated to be a feasible option in conjunction with 23-g transconjunctival sutureless vitrectomy to treat complex retinal detachment.
- Retina 01/2005; 25(2):208-11. · 2.83 Impact Factor
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ABSTRACT: To evaluate the safety and efficacy of 25-gauge instrumentation for a variety of vitreoretinal conditions on previously nonvitrectomized eyes. Single-center, retrospective, interventional case series. One-hundred forty eyes of 140 patients were evaluated at the Doheny Retina Institute from July 2002 to July 2003. All patients underwent surgical procedures using the Millennium 25-gauge Transconjunctival Standard Vitrectomy system. Twenty eyes (14.3%) underwent procedures without vitrectomy. Postoperative visual acuity (VA), intraocular pressure, surgical time, postoperative inflammation, complications, and number of sutured sites. No intraoperative complications were noted. No cases required conversion to 20-gauge machines. Ten cases (7.1%) involved single-site sclerotomy suture placement due to bleb formation at the conclusion of the procedure, but 5 of these entry sites were enlarged to facilitate larger instrumentation for tissue manipulation. Median VA improved from 20/250 (logarithm of the minimum angle of resolution, 1.08+/-0.47) preoperatively to 20/60 (0.47+/-0.30) (P<0.0001) at final visit. Mean follow-up was 33.8+/-9.7 weeks, and all eyes were observed for a minimum of 12 weeks. Mean total surgical time was 17.4+/-6.9 minutes. Intraocular pressures remained stable throughout the postoperative course. Five eyes (3.8%) presented on day 1 with shallow choroidal detachments, but all resolved by day 7, and none required volume infusion during the postoperative period. All but one of these cases was within the first 50 procedures performed. No detectable inflammation was noted in any eyes by 4 weeks postoperatively. No case of retinal detachment or endophthalmitis was recorded. Transconjunctival surgery using 25-gauge instrumentation may hasten postoperative recovery by decreasing overall surgical time and postoperative inflammation. Procedures requiring minimal intraocular manipulation did not require sutures and, thus, may be better suited for this surgical modality.Ophthalmology 06/2005; 112(5):817-24. · 5.56 Impact Factor
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ABSTRACT: To determine the efficacy of self-sealing pars plana sclerotomies for vitrectomy and to identify complications associated with this new technique. There were 150 self-sealing sclerotomies performed in 50 patients undergoing pars plana vitrectomy between October 1996 and March 1998. Of the 150 sclerotomies, 115 (76.6%) did not require suturing while 35 (23.3%) were closed with one radial 7.0 vicryl suture. The scleral tunnel incisions ensured minimal loss of intraocular fluids during instrument exchange and scleral plugs were not required to avoid ocular hypotony during scleral indentation. Distortion of scleral flap incisions requiring a suture were commonly seen in procedures using multiple instrumentations and extensive explants. Sutureless sclerotomies are simple to perform, save operative time, and reduce the risk of peroperative hypotony following removal of instruments or the infusion cannula. The technique reduces postoperative inflammation, suture-related problems including astigmatism, and allows more rapid rehabilitation.Ophthalmic surgery and lasers 31(6):462-6.