Elsevier

Ophthalmology

Volume 109, Issue 10, October 2002, Pages 1807-1812
Ophthalmology

A new 25-gauge instrument system for transconjunctival sutureless vitrectomy surgery1

Presented in part at the annual meeting of the American Academy of Ophthalmology, New Orleans, Louisiana, 2001.
https://doi.org/10.1016/S0161-6420(02)01179-XGet rights and content

Abstract

Objectives

To introduce and evaluate the infusion and aspiration rates and operative times of the 25-gauge transconjunctival sutureless vitrectomy system (TSV)

Design

In vitro experimental and comparative interventional study.

Participants and controls

Twenty eyes of 20 patients underwent a variety of vitreoretinal procedures using the 25-gauge TSV, including idiopathic epiretinal membrane (n = 10), macular hole (n = 4), rhegmatogenous retinal detachment (n = 3), branch retinal vein occlusion (n = 2), diabetic vitreous hemorrhage (n = 1), and 20 cases similar in diagnosis and severity were matched to provide comparison between duration of individual portions of the surgical procedures with the existing 20-gauge vitrectomy system.

Methods

Description of the 25-gauge TSV is provided; infusion and aspiration rates of the 25-gauge and standard 20-gauge vitrectomy system were measured in vitro using balanced saline solution and porcine vitreous for several levels of aspirating power and bottle height, and operating times of individual portions of surgical procedures were measured for the 25-gauge and 20-gauge vitrectomy system.

Main outcome measures

Infusion, aspiration rates, and operative times of the 20-gauge and 25-gauge vitrectomy system.

Results

Infusion and aspiration rates of the 25-gauge TSV system were reduced by an average of 6.9 and 6.6 times, respectively, compared with the 20-gauge system when balanced saline solution was used. The average flow rate of the Storz 25-gauge cutter (at 500 mmHg, 1500 cuts per minute [cpm]) was 40% greater than that of the 20-gauge pneumatic cutter (at 250 mmHg, 750 cpm) but about 2.3 times less than the 20-gauge high-speed cutter (at 250 mmHg, 1500 cpm). Mean total operative time was significantly greater for the 20-gauge high-speed cutter (26 minutes, 7 seconds) than for the 25-gauge vitrectomy system (17 minutes, 17 seconds) (P = 0.011).

Conclusions

Although the infusion and aspiration rates of the 25-gauge instruments are lower than those for the 20-gauge high-speed vitrectomy system, the use of 25-gauge TVS may effectively reduce operative times of select cases that do not require the full capability of conventional vitrectomy.

Section snippets

Materials and methods

The TSV consists of a 25-gauge microcannula system and a wide array of vitreoretinal instruments specifically designed for this operating system. Integral to this vitrectomy instrument system is the 25-gauge microcannula system, which includes a microcannula, an insertion trocar, an infusion cannula, a plug forceps, and a cannula plug.

The microcannula consists of a thin-walled polyamide tube 3.6 mm in length with an inner/outer diameter of 0.57/0.62 mm. A collar is present at the extraocular

Results

Infusion and aspiration rates of BSS for both the 20-gauge and 25-gauge infusion cannulas are in Figure 3, Figure 4. In general, the average infusion and aspiration rates of the TSV at various settings are reduced by 6.9 and 6.6 times, respectively, compared with the 20-gauge system. For both cannula sizes and vitrectors, infusion and aspiration rates decreased proportionally with decreasing bottle height and aspiration power.

During this study, procedures were performed on 20 consecutive

Discussion

Since the introduction of pars plana vitrectomy in the early 1970s by Machemer et al,1 advances in the field of vitreoretinal surgery have been dramatic. Machemer initially performed pars plana vitrectomy with the use of a 17-gauge (1.5-mm diameter) multifunctional instrument capable of cutting and aspirating the vitreous.9 This instrument used a fiberoptic sleeve and required a 2.3-mm scleral incision. In 1974, O’Malley and Heintz10 designed a smaller vitreous cutter with a diameter of 0.9 mm

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1

The new Transconjunctival Sutureless Vitrectomy System is disclosed to Bausch and Lomb Surgical, St. Louis, MO. The Microsurgery Advanced Design Laboratory (MADLAB) may receive royalties related to the sale of this and other instruments mentioned in the article.

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