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25-Gauge Vitrectomy for Pediatric Vitreoretinal Conditions
  1. Christine R Gonzales (cgonzales{at}retinaandvitreous.com),
  2. Surjeet Singh (surjeet20{at}hotmail.com),
  3. Steven D Schwartz (schwartz{at}jsei.ucla.edu)
  1. Retina and Vitreous Center, United States
  2. State University of New York, Downstate Medical Center, Brooklyn, New York, United States
  3. UCLA Jules Stein Eye Institute, United States

    Abstract

    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.

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