I was asked to review a paper for one of the journals on a large series (300+) of 25g transconjunctival vitrectomies. This brought back the arguments for and against this technique to the fore.
25G techniques have been blamed for the flexibility of instruments, the percieved inability to do peripheral work, and in the past for poor light. The light issue has long been sorted by modern sources such as the Photon. The flexibility of instruments, whilst real, can be overcome by changing technique. For instance when 'cleaning' a hole near the ora (very peripheral), traditionally one has the eye in a very tilted position to access the break. However, if you keep the eye flat - and use indentation to bring the area of interest to the vitrector, this problem is solved.
Here is a video clip of a round hole - very near the ora serrata being cleared of vitreous. Eye is flat, tndentation is used to bring the area of the hole to the cutter, thus avoiding the need to tilt the eye and providing a very controlled, very peripheral vitrectomy.
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Very interesting. I have recently shifted from 20G to 23G and have experienced the difficulties you have mentioned in 25G. These problems are temporary and will fade away without notice. All we need to discuss is the advantages and disadvantages (for the patient) of smaller incisions. If we can deliver the same quality of surgery with smaller incisions, then this is a worth doing.
ReplyDeleteRegards,
Dr Aamir Choudhry
The potential disadvanatage is an increased risk of endophthalmitis. Personally, I have not had this problem, but large series reported in the literature show a higher risk of endophthalmitis in transconjunctival sutureless surgery as compared to 20G sutured ports...
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