Intraoperative endoscopic observation of sclerotomy site after cannula removal for 23-gauge vitrectomy

Purpose: Transconjunctival sutureless vitrectomy(TSV) has become more commonly performed, but the incidence of sclerotomy site leakage is becoming an issue. We have developed a new and easy sclerotomy closure technique using cryotherapy, and named it ‘cryo-compression’.Methods: After the removal of the cannula, sclerotomy sites’ cryotherapy was performed with the setting of one cryospot for each site and ten seconds for each spot. After cryotherapy, firm pressure was maintained for more than 30 seconds. Immediately after compression, when any degree of leakage was detected, a single transconjunctival suture with 8-0 vicryl was placed. Postoperatively, topical steroid and antibiotics eyedrops were administrated.Results: Sixteen patients undergoing 23-gauge vitrectomy with this technique were reviewed retrospectively. The postoperative one- and six-hour intraocular pressures (IOPs) were significantly lower than preoperative IOP, but postoperative one-day and one-week IOPs were not different from preoperative IOP. Incidence of hypotony was 12.5% (N = 2/16 eyes) at only one hour but all eyes recovered. Intraoperative suture at sclerotomy sites was placed in eight of the 48 sclerotomies(16.7%) and suture placement was not required postoperatively. No cases of severe intraocular inflammation or endophthalmitis were indentified.Conclusions: Our short-term results are fairly respectable, so we think that the ‘Cryocompression’ technique is helpful to obtain sclerotomy closure in TSV.

Download Full-text

Aerosol generation through pars plana vitrectomy

British Journal of Ophthalmology ◽

10.1136/bjophthalmol-2020-317214 ◽

2020 ◽

pp. bjophthalmol-2020-317214

Author(s):

Hasan Naveed ◽

Fong May Chew ◽

Hanbin Lee ◽

Edward Hughes ◽

Mayank A Nanavaty

Keyword(s):

Pars Plana Vitrectomy ◽

Ex Vivo ◽

Dynamic Changes ◽

Aerosol Generation ◽

Significant Difference ◽

Optical Particle Counter ◽

Pars Plana ◽

23 Gauge ◽

Set Up ◽

Ex Vivo Study

PurposeTo assess whether pars plana vitrectomy (PPV) is an aerosol-generating procedure (AGP) in an ex vivo experimental model.MethodsIn this ex vivo study on 10 porcine eyes, optical particle counter was used to measure particles ≤10 μm using cumulative mode in the six in-built channels: 0.3 μm, 0.5 μm, 1 μm, 2.5 μm, 5 μm and 10 μm aerosols during PPV. Two parts of the study were as follows: (1) to assess the pre-experimental baseline aerosol count in the theatre environment where there are dynamic changes in temperature and humidity and (2) to measure aerosol generation with 23-gauge and 25-gauge set-up. For each porcine eye, five measurements were taken for each consecutive step in the experiment including pre-PPV, during PPV, fluid–air exchange (FAX) and venting using a flute with 23-gauge set-up and a chimney with 25-gauge set-up. Therefore, a total of 200 measurements were recorded.ResultsWith 23-gauge and 25-gauge PPV, there was no significant difference in aerosol generation in all six channels comparing pre-PPV versus PPV or pre-PPV versus FAX. Venting using flute with 23-gauge PPV showed significant reduction of aerosol ≤1 μm. Air venting using chimney with 25-gauge set-up showed no significant difference in aerosol of ≤1 μm. For cumulative aerosol counts of all particles measuring ≤5 μm, compared with pre-PPV, PPV or FAX, flute venting in 23-gauge set-up showed significant reduction unlike the same comparison for chimney venting in 25-gauge set-up.ConclusionPPV and its associate steps do not generate aerosols ≤10 μm with 23-gauge and 25-gauge set-ups.

Download Full-text

Endoscopic observation of the hypopharyngeal region using a super soft hood

Digestive Endoscopy ◽

10.1111/den.13918 ◽

2021 ◽

Author(s):

Takahiro Inoue ◽

Ryu Ishihara ◽

Takashi Fujii

Keyword(s):

Endoscopic Observation

Download Full-text

Combined pars plana glaucoma drainage device placement and vitrectomy using a vitrectomy sclerotomy site for tube placement: a case series

BMC Ophthalmology ◽

10.1186/s12886-021-01872-z ◽

2021 ◽

Vol 21 (1) ◽

Cited By ~ 1

Author(s):

Enchi Kristina Chang ◽

Sanchay Gupta ◽

Marika Chachanidze ◽

John B. Miller ◽

Ta Chen Chang ◽

...

Keyword(s):

Visual Acuity ◽

Pars Plana Vitrectomy ◽

Case Series ◽

Tube Placement ◽

Glaucoma Drainage Device ◽

Drainage Device ◽

Glaucoma Drainage Devices ◽

Pars Plana ◽

Sclerotomy Site

Abstract Purpose The purpose of this study is to report the safety and efficacy of pars plana glaucoma drainage devices with pars plana vitrectomy using one of the vitrectomy sclerotomy sites for tube placement in patients with refractory glaucoma. Methods Retrospective case series of 28 eyes of 28 patients who underwent combined pars plana glaucoma drainage device and pars plana vitrectomy between November 2016 and September 2019 at Massachusetts Eye and Ear. Main outcome measures were intraocular pressure (IOP), glaucoma medication burden, best corrected visual acuity, and complications. Statistical tests were performed with R and included Kaplan-Meier analyses, Wilcoxon paired signed-rank tests, and Fisher tests. Results Mean IOP decreased from 22.8 mmHg to 11.8 mmHg at 1.5 years (p = 0.002), and mean medication burden decreased from 4.3 to 2.1 at 1.5 years (p = 0.004). Both IOP and medication burden were significantly lower at all follow-up time points. The probability of achieving 5 < IOP ≤ 18 mmHg with at least 20% IOP reduction from preoperative levels was 86.4% at 1 year and 59.8% at 1.5 years. At their last visit, three eyes (10.7%) achieved complete success with IOP reduction as above without medications, and 14 eyes (50.0%) achieved qualified success with medications. Hypotony was observed in 1 eye (3.6%) prior to 3 months postoperatively and 0 eyes after 3 months. Visual acuity was unchanged or improved in 23 eyes (82.1%) at their last follow-up. Two patients had a visual acuity decrease of > 2 lines. Two eyes required subsequent pars plana vitrectomies for tube obstruction, and one eye had transient hypotony. Conclusions The results of pars plana glaucoma drainage device and pars plana vitrectomy using one of the vitrectomy sclerotomy sites for tube placement are promising, resulting in significant IOP and medication-burden reductions through postoperative year 1.5 without additional risk of postoperative complications. Inserting glaucoma drainage devices into an existing vitrectomy sclerotomy site may potentially save surgical time by obviating the need to create another sclerotomy for tube placement and suture one of the vitrectomy ports.

Download Full-text

Lens and Peripheral Retinal Relationships During Vitrectomy: Comparison of 23-, 25-, and 27-Gauge Vitrectomy and Curved Endolaser Probes

Journal of VitreoRetinal Diseases ◽

10.1177/2474126420971979 ◽

2020 ◽

pp. 247412642097197

Author(s):

Jacob S. Duker ◽

Michael J. Venincasa ◽

Pedro F. Monsalve ◽

Armando L. Garcia ◽

Sander R. Dubovy ◽

...

Keyword(s):

Insertion Site ◽

Crystalline Lens ◽

Peripheral Retina ◽

Small Gauge ◽

The Mean ◽

Deceased Donors ◽

23 Gauge ◽

Considerable Range ◽

Safe Access ◽

Phakic Eyes

Purpose: This work aims to compare spatial relationships between the crystalline lens and vitrectomy instruments of different gauges. Methods: Eight phakic eyes recovered from deceased donors were used after fixation. Valved trocars (27-gauge, 25-gauge, and 23-gauge) were sequentially placed in the superotemporal quadrant 4 mm posterior to the limbus in each eye. Intraocular relationships of vitrectomy and curved endolaser probes were measured for each gauge. Results: There were no significant differences in maneuverability between instruments of different gauges. The mean distance from instrument to lens at the geometric center of the globe was 5.5 mm. Vitrectomy probes of all gauges could access the peripheral retina on both sides of the sclerotomy in the 3 to 4 o’clock position adjacent to the sclerotomy without touching the lens. The instruments could be advanced without lens touch to contact the retina within at least 2 mm of the ora serrata 180° away from the insertion site. Conclusions: Vitrectomy and curved endolaser probes achieved similar maneuverability relative to the lens regardless of gauge. This study confirms that small-gauge vitrectomy instruments have a considerable range of safe access to the peripheral retina in phakic eyes from a single sclerotomy.

Download Full-text