Study objective: To evaluate the feasibility and safety of 25-gauge vitrectomy for various vitreoretinal indications in the pediatric population.
Methods: Consecutive patients aged 18 years or less undergoing vitrectomy for various vitreoretinal indications over a 5-year period were studied retrospectively. Two different surgical techniques were used: a modified 25-gauge approach in which the sclerotomies and conjunctiva were sutured as described previously for most children under the age of one year, and a transconjunctival 25-gauge approach for older children.
Results: 56 eyes in 49 children (16 girls and 33 boys) were included. Intra-operative unplanned events or complications included: conversion to 20-gauge vitrectomy (4), conversion of one port to a 20-gauge sclerotomy (2), suspected lens damage (1), intraoperative bleeding from a vascular ridge (1). Post-operative complications included cataract (5), rhegmatogenous retinal detachment (4), and vitreous hemorrhage (3). The 4 retinal detachments were either recurrent or occurred in eyes with complex ocular pathology and were not felt to be related to the surgical technique. There were no cases of post-operative hypotony requiring intervention, choroidal detachment, endophthalmitis, or sclerotomy-related retinal breaks.
Conclusions: 25-gauge vitreoretinal techniques can be used in various pediatric vitreoretinal conditions and facilitate easy access to small spaces in the pediatric eye. To avoid post-operative hypotony, a modified technique is recommended for younger babies in which the conjunctiva and sclera is sutured.