European VitreoRetinal Society a certain philosophy

Poster Mehmet Onen Purpose: To compare anatomical and functional outcomes of 25 gauge and 23 gauge transconjunctival sutureless vitrectomy (TSV) for treatment of proliferative diabetic retinopathy (PDR). Methods: Retrospective review of 81 consecutive eyes from 81 patients undergoing 25 gauge and 23 gauge TSV with a minimum of 6-month follow-up (vitreous hemorrhage (VH), n=51; tractional retinal detachment (TRD), n=30). Vitrectomy was...

Purpose: To share the problems of 23g PPV for patients with retinal detachment and choroidal detachment. Material & Methods: Seven patients with retina and choroidal detachment were included in this study. Preoperative and other routine eye examination [BCVA, biomicroscopy, intraocular pressure, fundoscopy, A-B scan ultrasonography if needed] were recorded. The surgical findings and complications were recorded [infusion cannula...

Technological advances in 23 gauge probe design and vitrectomy machines, allowed the use of the probe to perform many intraoperative techniques and manipulations during complex diabetic vitrectomy. The aim of this work is to describe techniques for using the 23 gauge vitrectomy probe to manage complex diabetic vitrectomy. 120 eyes with severe complications of proliferative diabetic retinopathy were included in this work. They include cases...

We have to perform our surgical techniques with utmost efficacy, widest safety margin, and least cost. Some instruments can be fashioned oneself in a way that achieves all targets of 23 gauge vitrectomy: 1. Intravitreal triamcinolone acetonide cannula 2. Heavy liquid (PFC) cannula 3. 23 gauge needle pick 4. Silicone oil cannula 5. Non-bent 23 gauge needle for ILM flap creation. By being able to fashion some simple instruments one can t...

An intraocular foreign body (IOFB) must be excluded in all cases of eye perforation. An IOFB may traumatize the eye mechanically, introduce infection or cause other toxic effects (i.e.: siderosis) on the intraocular structures. Once in the eye, the foreign body may lodge in any of the structures (in the antherior chamber, in the angle, in the lens, in the vitreous or on the retina).Some of them are inert but an intraocular ferrous foreign...

Setting: Vitreoretinal department, clinique Sourdille, Nantes, France Purpose: Although transconjunctical sutureless vitrectomy is a major step forward in vitreoretinal surgery when compared to 20 gauge vitrectomy, it has its own set of complications and shortcomings. We present in this film a series of complications we could record during the last five years. Methods: We selected an anthology of complications and shortcomings specific...

Clinical Outcomes of Ultrahigh-speed 23 G with Duty Cycle Control System in the Treatment of PDR Complicated by Tractional RD Jung Ho Lee Advantages:          Dealing with vitreous of detached retina with fibrovascular proliferation and traction complicated by proliferative diabetic retinopathy is a challenge. A higher cutter rate may minimize vitreous turbulence by allowing only small bits of vitreous to enter the port,...

Introduction: While peeling an idopathic epiretinal membrane with a standard 23-gauge vitrectomy the Infusion port dislocated inadvertently and caused a massive uveal effusion. Methods: By using an additional 20-gauge sclerotomy, it is possible to continue the vitrectomy, peeling the macular pucker and the inner limiting membrane in order to successfully complete the surgery. In this case, the 20-gauge sclerotomy serves as a drainage...

We present the case of a 75-years-old male patient with decreased visual acuity from vitreous hemorrhage. Visual acuity was hand movement. We performed 23 G pars plana vitrectomy under topical anesthesia. The patient was very interested in all surgical procedures. We communicated with him during the surgery. The procedure was completed in approximately twenty minutes without any complications. In both the intraoperative and postoperative...

Hassan Mortada (Cairo, Egypt) Advantages: To evaluate the efficacy of using only 23g transconjuntival sutureless vitrectomy in management of complicated retinal detachment over the past 3 years. The preservation of the integrity of the conjunctiva and sclera in these cases is of crucial importance, as these cases frequently need more than one operation, at least to remove silicone oil. This is a major advantage of 23G over 20G. The...

Isil Pasaoglu, Hülya Güngel, Sevil Karaman, Dilek Alp, Ozen Osmanbasoglu, Ece Uzun (Istanbul, Turkey) Advantages: To analyse the factors affecting visual outcomes of 23-gauge transconjunctival sutureless vitrectomy combined with phacoemulsification in phakic rhegmatogenous retinal detachment. Methods: A retrospective case series study was performed in 56 patients with phakic retinal detachment. Patients with a final visual acuity greater...

Hülya Güngel, Isil Pasaoglu, Evre Pekel, Dilek Alp, Ozen Osmanbasoglu, Ece Uzun (Istanbul, Turkey) Methods: Forty-five patients with pseudophakic retinal detachment were analyzed retrospectively. Patients with a final visual acuity greater than 0,1 (snellen equivalent) were defined as having a good visual prognosis. Parameters examined were age, gender, duration of the symptoms, preoperative visual acuity, preoperative intraocular...

Sungjin Na, Yongbaek Kim, Keunsung Park, Eunjung Lee, Eunkyoung Lee (Daejeon, South Korea) Advantages: To reduce patient’s cost and facilitate early rehabilitation in day surgery. Methods: After performing 23-gauge vitrectomy, we prospectively compared the 3-month follow-up results of day surgery cases (79 eyes) and 1-day admission cases (72 eyes). Effectiveness / Safety: Between 2 groups, improvement of best-corrected visual acuity...

http://www.evrs.eu/medias/2010/videos/EnricoBertelli_VP6_768K.flv Enrico Bertelli, Paolo Pelanda (Bolzano, Italy) Advantages: 23 Gauge transconjunctival vitrectomy is a minimally invasive vitreoretinal technique that offers the advantages of sutureless surgery combined with the benefits of a sturdy instrumentation, this latter feature making it potentially suitable for a large number of indications. Methods: The video highlights the...

http://www.evrs.eu/medias/2009/videos/MariaGarciaPous_VP6_768K.flv Authors: Maria Garcia-Pous, E. Palacios, J. Mataix, M.C. Desco, A. Navea, Valencia, Spain Advantages: To show small problems during 23 gauge vitreoretinal surgery. Methods: We show several surgeries where arise little handicaps such as gas / air running away through the sclerotomies at the end of surgery, liquid infusion springing through the trocar, or perfluorocarbon...

Cian Roberto, Tavolato Marco, Caretti Luigi, Galan Alessandro Purpose: To describe a new technique that allow to perform a complete vitrectomy with only two sclerotomy. Methods: In this single center, interventional case series comprised 5 eyes of 5 patients with posterior pole disease (2 eyes with hemovitreous, 2 with diabetic retinopaty, 1 with macular hole stage 4) who had two port 23 gauge vitrectomy with slit lamp illumination. The...

Cesare Forlini, Paolo Rossini, Antonio Aversano (Department of Ophthalmology, “S. Maria delle Croci” Hospital, Ravenna, Italy)Matteo Forlini (Eye Clinic, University of Modena, Italy) Advantages: To show the effectiveness and the safety of the 23 gauge system for full macular translocation in age-related macular degeneration. Methods: In a case of pseudophakic exudative macula degeneration a standard three port 23 gauge vitrectomy is...

Zoran Tomic, Wamidh Simawi, Steffen Schulz-Key and Bengt Schepke Advantages: A wide choice of 23-gauge instruments and their good properties such as right size and stiffness make it possible to treat cases with complex pathology including complications of proliferative diabetic retinopathy, proliferative vitreoretinopahty (PVR), retinal detachment with giant retinal tears, retinal detachment-retinoschisis and complications of retinal vein...

I. Turco, V. Primavera, G. Schiena, G. Querques, A. de Giglio, C. Iaculli, N. Delle Noci Advantages: To use 25 gauge vitrectomy to remove little intra-ocular foreign body Methods: Ocular trauma is a major cause of permanent visual loss or blindness in young adults in the western world. We report a case of a 46 year-old man hospitalized for a penetrating wound, after accidental entry of a foreign body. Ultrasound and CT, preferably with...

Vyslouzilova D., Vlkova E. Advantages: Rhexis of posterior capsule via pars plana by using 25G instrumentarium is more suitable for patients, who have risk factors for usual polishing of posterior capsule or for Nd YAG capsulotomy. Methods: We use usual instrumentarium for 25 G vitrectomy. We perform only one sclerotomy in pars plana area and we make posterior capsulotomy using 25 G vitrectomy. Sclerotomy is sutureless. Effectiveness /...

Hulya Gungel, Deniz Oygar Baylancicek, Isil Basgil, Nihat Sayin, Eylem Yaman Pinarci Purpose: To evaluate the anatomic and visual outcomes of 23-gauge transconjunctival sutureless vitrectomy for a variety of vitreoretinal conditions in patients with diabetic retinopathy. Methods: A retrospective, consecutive, interventional case series for 21 eyes of 20 patients with proliferative diabetic retinopathy. Patients underwent vitreoretinal...

http://www.evrs.eu/medias/2008/congress/Mini-Invasive-Surgery-Yes:-Sutureless-No-Thanks.flv Cesare Forlini, Paolo Rossini, Antonio Aversano (Department of Ophthalmology, “S. Maria delle Croci” Hospital, Ravenna, Italy), Matteo Forlini (Eye Clinic, University of Modena, Italy) Advantages: To show the effectiveness to use the scleral suture in mini-invaseive 25/23 gauge systems. Methods: Both 25 and 23 gauge trocars are inserted through...

http://www.evrs.eu/medias/2008/congress/Mini-Invasive-25-23-Gauge-Systems:-Expanded-Indications.flv Cesare Forlini, Paolo Rossini, Antonio Aversano (Department of Ophthalmology, “S. Maria delle Croci” Hospital, Ravenna, Italy), Matteo Forlini (Eye Clinic, University of Modena, Italy) Advantages: To show there are no limits in the use of mini-invasive transconjunctival surgery. Methods: Several cases of particular and complex cases are...

http://www.evrs.eu/medias/2008/congress/Untoward-Outcomes-in-23-Gauge-Vitrectomy-Surgery.flv Zoran Tomic Advantages: Absence of suture-induced astigmatism, more efficient surgery, reduced risk for vitreous incarceration and enhanced postoperative recovery are well known advantages of the transconjunctival sutureless vitrectomy surgery. Thus, recently published results of larger series have demonstrated the high rate of severe operative...

http://www.evrs.eu/medias/2008/congress/Do-Advances-in-Technology-Improve-Micro-Incisional-Vitrectomy-Success.flv Stanislao Rizzo, Federica Genovesi-Ebert Advantages: Despite its clinical advantages, Micro Incisional Vitrectomy (MIVS) pose significant challenges in performing water-airtight incisions and in thick membranes removal due to the scarce tools efficiency. Improvement of MIVS instrumentation may allow overcoming these drawbacks....

Octaviano Magalhaes, MD (Los Angeles, CA), Lawrence P. Chong, MD (Los Angeles, CA), Charles DeBoer, PhD (Los Angeles, CA), Prashant R. Bhadri, PhD (Los Angeles, CA), Matheus McCormick, BS (Los Angeles, CA), Ralph Kerns, MS (Los Angeles, CA), Aaron Barnes, MS (Los Angeles, CA), Mark S. Humayun, MD, PhD (Los Angeles, CA)* PURPOSE: To evaluate porcine vitreous and Balanced Saline Solution (BSS) flow rates and correlate these flows with...

Oswaldo Ferreira Moura Brasil, MD (Rio De Janeiro, Brazil),* Rishi P. Singh, MD (Cleveland, OH), Rafael L. Ufret-Vincenty, MD (Cleveland, OH), Hajime Bando, MD (Cleveland, OH), Peter K. Kaiser, MD (Cleveland, OH)* PURPOSE: To evaluate wound healing characteristics and time course after 23 and 25 gauge sutureless cannula systems with either perpendicular or angled incisions by clinical and histopathological outcomes. METHODS: Three-port pars...

George A. Williams, MD (Royal Oak, MI)* PURPOSE: A new 23 gauge vitrectomy system based on the Acurus platform has been developed to enhance the advantages of sutureless transconjunctival vitrectomy while minimizing the disadvantages. METHODS: This 23 gauge system employs a single pass, transconjunctival cannula system which creates selfsealing pars plana entry site wounds. The larger instrumentation compared to 25 gauge decreases...

Zoran Tomic, (Uppsala, Sweden), Nasser Jadidi Gili, MD (Uppsala, Sweden), Ioannis P.Theocharis, MD (Athens, Greece) PURPOSE: To refer on suitable indications and applicability of various surgical procedures using a new 23g sutureless vitrectomy technique. METHODS: A consecutive series of 100 operated eyes using 25g sutureless technique were compared with a consecutive series of 100 operated eyes using a new 23g technique regarding...

http://www.evrs.eu/medias/2006/congress/Further-Experience-with-23-Gauge-Transconjunctival-Vitrectomy.swf http://www.evrs.eu/medias/2006/congress/Further-Experience-with-23-Gauge-Transconjunctival-Vitrectomy-1.flv http://www.evrs.eu/medias/2006/congress/Further-Experience-with-23-Gauge-Transconjunctival-Vitrectomy-2.flv http://www.evrs.eu/medias/2006/congress/Further-Experience-with-23-Gauge-Transconjunctival-Vitrectomy-3.flv Claus Eckardt,...

Harinderjit Singh, MD (Augusta, Georgia), Dennis M. Marcus, MD (Augusta, GA), Micah Manning, MD (Columbia, SC), Jasleen Singh, BS (Augusta, Georgia) PURPOSE: To report short-term outcomes and complications from the first 100 eyes undergoing 23-gauge transconjunctival sutureless vitrectomy (Dutch Ophthalmics). METHODS: Forty eight females and 52 males, average age of 65 years (range 29-94 years), underwent 23-gauge vitrectomy by two surgeons...

http://www.evrs.eu/medias/2006/videos/Multi-gauge-Evolution.flv Zoran Tomic, MD (Uppsala, Sweden) SYNOPSIS The film is going to present in a funny way difficulties that VR-surgeon meets using 20-and 25-gauge vitrectomy techniques. It is going to explain several reasons why to choose the 23-gauge as a standard operating technique.

http://www.evrs.eu/medias/2006/videos/23-gauge-Vitrectomy-Not-Too-Big,-Not-Too-Small,-Just-%20Right.flv Edgar L. Thomas, MD (Beverly Hills, CA)* SYNOPSIS From the inception of vitrectomy in the early 1970s as a single port multifunctional instrument to 3 port 20-gauge, to 25-gauge and now potentially to 23-gauge, the evolution has taken the first step to larger instrumentation. This video compares the 20-g, 25-g and 23-g insertion and...

http://www.evrs.eu/medias/2006/congress/23-Gauge-Vitrectomy-as-an-Effective-and-Safe-Alternative-for-Sutureless-Vitreous-Surgery.swf http://www.evrs.eu/medias/2006/congress/23-Gauge-Vitrectomy-as-an-Effective-and-Safe-Alternative-for-Sutureless-Vitreous-Surgery.flv Keith A. Warren, MD (Overland Park, KS) PURPOSE: To evaluate the safety and effectiveness of the 23-gauge vitrectomy system (DORC) as a treatment modality for a variety of...

http://www.evrs.eu/medias/2006/videos/A-New-Step-in-Sutureless-Vitrectomy-Technique.flv Jean-Pierre Hubschman, MD (Saint Jean De Luz, France) SYNOPSIS The latest sutureless vitrectomy 23 and 25 gauge techniques help decrease the surgical traumatism and improve the post op comfort. Unfortunately, both trans-conjunctival systems do not have only positive aspects. A new sutureless vitrectomy technique has been developed combining the...

http://www.evrs.eu/medias/2006/videos/Beveled-Cannula-Placement-for-23-and-25-Gauge-Vitrectomy.flv Robert L. Avery, MD (Santa Barbara, CA)* SYNOPSIS Beveled entry with 23 and 25 gauge trocar/cannula systems for vitrectomy are demonstrated. The entry is rapid and does not require specialized instru-ments. This simple modification of the introduction of the cannula allows for a self-sealing wound – thereby poten-tially lowering the risk of...

http://www.evrs.eu/medias/2006/videos/Peeping-GRIN.flv Frank H.J. Koch, MD (Frankfurt am Main, Germany), Pankaj Singh, MD (Frankfurt am Main, Germany) SYNOPSIS Once upon a time all retina specialists had agreed in a 19/20 gauge PPV standard. One day, techno-logical progress had driven some of the experts to declare a smaller gauge (25/23) PPV to be a new standard. Smaller was considered to be faster, safer, less traumatic and certainly...

Robert L. Avery, MD (Santa Barbara, CA) SYNOPSIS Beveled entry with 23 and 25 gauge trocar/cannula systems for vitrectomy are demonstrated. The entry is rapid and does not require specialized instru-ments. This simple modification of the introduction of the cannula allows for a self-sealing wound – thereby poten-tially lowering the risk of hypotony, wound leak, and endophthalmitis. ...

Frank H.J. Koch, MD (Frankfurt am Main, Germany), Pankaj Singh, MD (Frankfurt am Main, Germany) SYNOPSIS Once upon a time all retina specialists had agreed in a 19/20 gauge PPV standard. One day, techno-logical progress had driven some of the experts to declare a smaller gauge (25/23) PPV to be a new standard. Smaller was considered to be faster, safer, less traumatic and certainly better looking – from outside. No opening of the...

Zoran Tomic, MD (Uppsala, Sweden) SYNOPSIS The film is going to present in a funny way difficulties that VR-surgeon meets using 20-and 25-gauge vitrectomy techniques. It is going to explain several reasons why to choose the 23-gauge as a standard operating technique. ...

Howard F. Fine, MD (New York, NY), Richard F. Spaide, MD (New York, NY), Reza Iranmanesh, MD (New York, NY), Diana Iturralde, MD (Pamplona, Spain) PURPOSE: Twenty-five gauge vitrectomy systems possess several advantages over 20-g methods including improved wound healing, conjunctival sparing, and patient comfort. Newer 23-g systems were introduced to improve instrument bore size and rigidity while retaining sutureless technique. The...

Ioannis P. Theocharis, MD (Athens, Attica, Greece), Zoran Tomic, MD (Uppsala, Sweden), Anastassia Alexandridou, MD, PhD (Athens, Greece) PURPOSE: To evaluate the safety and patients’ tolerance to topical anaesthesia in vitreoretinal surgery. METHODS: 38 (n=38) patients (group A) were operated with 25g (n=25) and 23g (n=13) vitrectomy under topical anaesthesia with 2% lidocaine gel, for various vitreoretinal diseases (macula holes,...

Dagmar Dotrelova, MD, PhD (Prague, Czech Republic), Tereza Lainova Vrabcova, MD (Prague, Czech Republic), Jan Kvasnicka, MD (Prague, Czech Republic), Martin Hlozanek, MD (Prague, Czech Republic) PURPOSE: Case report showing complex diagnostics and therapy in young man with central retinal vein occlusion (CRVO). METHODS: CRVO is typically found in population over 60, vascular and hematological disorders are another risk factors. Retinal...

Jean-Pierre Hubschman, (Saint Jean De Luz, France) PURPOSE: The latest sutureless vitrectomy 23 and 25 Gauge techniques help decrease the surgical traumatism and improve the post op comfort. Unfortunately, both transconjonctival systems do not have only positive aspects. A new sutureless vitrectomy technique has been developped combining the main advantages of both 23 and 25G techniques. METHODS: This technique uses a new pack including 23...

http://www.evrs.eu/medias/2005/congress/Our-Experience-with-New-Techniques-in-Macular-Surgery:-25G-and-23G.swf http://www.evrs.eu/medias/2005/congress/Our-Experience-with-New-Techniques-in-Macular-Surgery:-25G-and-23G.flv Zoran Tomic, Nasser Jadidi Gili, Ioannis Theocharis Purpose: To report on our results using two new sutureless surgical techniques in the treatment of macular disorders. Methods: Retrospective study on 43 consecutive eyes...