Introduction:

In the last years vitreoretinal surgery underwent major technical advances, especially with the most recent high frequency vitrectors and microincision systems with progressively smaller caliber, such as the 27-gauge vitrectomy system. This video aims to illustrate our pars plana vitrectomy experience with this small-gauge vitrectomy system.

Material and Methods:

Retrospectively we selected and analyzed all patients that underwent 27-gauge posterior vitrectomy in the last 3 years in our center (2013-2015). In all cases the platform with 7 500 cuts per minute of Constellation® (Alcon, USA) System was used. When membrane peeling was needed (epiretinal or internal limiting membrane), MembraneBlue-Dual® (DORC, International) or Doubledyne® (Kemin Pharma, USA) dyes were used to stain, as well as a 27-gauge forceps (Ref 711.44, Grieshaber, USA) to remove the membranes. Surgical and vitrectomy time, need for sclerotomy suture, intra-operatory difficulties, complications and post-operatory results were analyzed.

Results:

We included 10 patients, ranging from 30 to 80 years old, 8 females. The motives for surgery were rhegmatogenous retinal detachment (1); epiretinal membrane (6), non-myopic macular schisis (1); myopic lamellar macular hole (1); full thickness macular hole (1, with inverted flap technique). One of the epiretinal membrane surgeries was combined with femtofaco surgery (LenSx® Laser, Alcon, USA). Mean time of surgical interventions was superior to the other systems with larger caliber, by taking more time to complete the vitrectomy. Epiretinal or internal limiting membranes were removed without difficulties. Intraoperative globe manipulation was limited with the 27-gauge instruments, being more difficult to complete peripheral vitrectomy and ending the surgery with deformed instruments. None of the cases needed sclerotomy suture. In the post-operatory anatomical and functional success was achieved, without significant complications in all cases.

Conclusions:

Microincision pars plana vitrectomy with 27-gage system allows less invasive and traumatic interventions, which will probably result in better and quicker postoperative results. However we cannot forget that to take the most out of its potential we have to overcome the learning curve and weight the additional cost of this system.

Contact Details:

Email: filh1967@gmail.com

Filipe Henriques