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      A novel, low-cost and practical illumination approach for bimanual vitrectomy

      research-article
      , ,
      Northern Clinics of Istanbul
      Kare Publishing
      Bimanual vitrectomy, endoillumination, vitrectomy

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          Abstract

          OBJECTIVE:

          The present study aims to describe a novel, low-cost, transconjunctival sutureless bimanual vitrectomy illumination approach and evaluate its surgical outcome.

          METHODS:

          Thirty-six eyes of 36 patients who underwent pars plana vitrectomy with the above-mentioned technique were included in this study. Four trocars were placed in superotemporal, inferotemporal, inferonasal and superonasal quadrants. A piece (23 mm) was cut from 30G intravenous cannula and a 30 mm endoillumination probe was placed inside this sleeve. This design limited the entry of the light probe into the vitreous cavity to 7 mm and provided a safe illumination by the assistant without the risk of damaging the retinal tissue.

          RESULTS:

          Thirty-six eyes of 36 patients were included (24 male, 12 female, mean age: 58.4±14.3 years) in this study. Thirty patients had rhegmatogenous retinal detachment (six of these patients with coexisting choroidal detachment), four patients had diabetic tractional retinal detachment, one patient had a nucleus drop and one patient had an intraocular foreign body. The mean follow-up time after pars plana vitrectomy (PPV) was 5.05±4.4 months. LogMAR best-corrected visual acuity improved significantly after PPV (p<0.001). Postoperative complications included recurrent detachment in two eyes, hypotony in one eye and endophthalmitis in one eye. The transient rise in intraocular pressure was observed in 19 patients, but there was no significant difference between the preoperative and postoperative mean IOP in the long term follow-up.

          CONCLUSION:

          This bimanual vitrectomy system provided favorable outcomes without increasing the cost of standard PPV. The advantage of this system over the chandelier illumination include the reduction in glare, the possibility to change the direction of the light during the surgery to better illuminate the surgical site and the lower cost. This approach can be used in any vitrectomy system (20G, 23G, 25G, and 27G) by changing the size of the IV cannula.

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          Most cited references13

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          25-gauge vs 20-gauge system for pars plana vitrectomy: a prospective randomised clinical trial.

          To compare 25-gauge vs 20-gauge system for pars plana vitrectomy in a prospective, randomised, controlled clinical trial. Three-port pars plana vitrectomy was performed in 60 patients belonging to 2 groups. Evaluations were performed preoperatively, intraoperatively, during the first three postoperative days, at 1 week, and at 1 and 3 months. The main outcome measure was time for surgery, divided into duration of wound opening, vitrectomy, retinal manipulation and wound closure. The total duration of surgery showed no significant difference between the groups (p = 0.67). The 25-gauge group showed significantly shorter duration of wound opening (p<0.001) and wound closure (p<0.001). In contrast, the vitrectomy duration was significantly longer in the 25-gauge group (p<0.001). Conjunctival injection and subjective postoperative pain showed significantly lower irritation in the 25-gauge group (p<0.001 for both). The 25-gauge vitrectomy system offered significantly improved patient comfort during the first postoperative week. The smaller surgical openings facilitated wound healing and minimised pain. Duration of surgery was comparable between the two systems-the shorter time needed for wound opening and closure in the 25-gauge group being equalised by the longer vitrectomy duration. Intraoperative as well as retinal manipulation and illumination caused more surgical difficulties using the 25-gauge system.
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            Scleral Buckling with a Non-Contact Wide-Angle Viewing System

            Purpose: To assess the outcome of scleral buckling surgery using a non-contact wide-angle viewing system for fundus visualization in patients with rhegmatogenous retinal detachment without proliferative vitreoretinopathy. Patients and Methods: Sixteen eyes of 16 patients underwent scleral buckling using a non-contact wide-angle viewing system combined with a 25-gauge illumination fibre inserted into the sclera at the pars plana. Results: The mean age of the patients was 53.6 ± 13.7 years and the mean follow-up time was 13.4 ± 2.8 months. Retinal reattachment was achieved in 13 of the 16 eyes (81%). Three eyes underwent vitrectomy with silicone oil injection because of development of proliferative vitreoretinopathy in 2 eyes and scleral perforation due to excessive indentation during cryoretinopexy in 1 eye. Two eyes developed limited subretinal haemorrhage during subretinal fluid drainage. Conclusion: Simultaneous use of a non-contact wide-angle viewing system combined with a 25-gauge light fibre illumination for fundus visualization brings the advantages of microsurgery and indirect ophthalmoscopy into scleral buckling surgery.
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              Review of Small Gauge Vitrectomy: Progress and Innovations

              Purpose. To summarise the surgical advances and evolution of small gauge vitrectomy and discuss its principles and application in modern vitreoretinal surgery. The advent of microincisional vitrectomy systems (MIVS) has created a paradigm shift away from twenty-gauge vitrectomy systems, which have been the gold standard in the surgical management of vitreoretinal diseases for over thirty years. Advances in biomedical engineering and surgical techniques have overcome the technical hurdles of shifting to smaller gauge instrumentation and sutureless surgery, improving surgical capabilities and expanding the indications for MIVS.
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                Author and article information

                Journal
                North Clin Istanb
                North Clin Istanb
                Northern Clinics of Istanbul
                Kare Publishing (Turkey )
                2148-4902
                2536-4553
                2020
                11 February 2020
                : 7
                : 3
                : 275-279
                Affiliations
                [1]Department of Ophthalmology, Istanbul Medeniyet University Faculty of Medicine, Istanbul, Turkey
                Author notes
                Correspondence: Dr. Veysel AYKUT. Istanbul Medeniyet Universitesi, Goztepe Egitim ve Arastirma Hastanesi, Goz Hastaliklari Klinigi, Kadikoy, Istanbul, Turkey. Tel: +90 505 453 45 70 e-mail: v-aykut@ 123456hotmail.com

                This work was previously presented at the 52 nd National Ophthalmology Congress organized by Turkish Ophthalmological Society on November 2018 in Antalya.

                Article
                NCI-7-275
                10.14744/nci.2020.21704
                7251264
                bf6305d2-1320-4624-a3ff-0199c25e1501
                Copyright: © 2020 by Istanbul Northern Anatolian Association of Public Hospitals

                This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License

                History
                : 02 September 2019
                : 21 January 2020
                Categories
                Original Article

                bimanual vitrectomy,endoillumination,vitrectomy
                bimanual vitrectomy, endoillumination, vitrectomy

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