http://www.evrs.eu/medias/2006/congress/Outcomes-of-25-Gauge-Transconjonctival-Membrane-Peeling-Combined-with-Sutureless-Phaco-IOL-Surgery.swf

Jean-Paul Berrod, MD (Nancy, France), Isabelle Hubert, MD (Nancy, France), Angélique Poirson, resident (Nancy, France), Marie-Christine Bazard, MD (Nancy, France), Alexandre Guillaubey, resident (Dijon, France), Gregoire Minoyan, MD (Nancy, France), Catherine Creuzot-Garcher, MD (Dijon, France)

PURPOSE:

To evaluate the safety and efficacy of 25 gauge vitrectomy for ILM peeling combined with sutureless phaco IOL surgery.

METHODS:

Prospective interventional case series of 50 eyes operated by one surgeon. All patients underwent surgical procedures using peristaltic vitrectomy machine with a 25 gauge probe with the flow control set at 4 mL/min and maximum depression set at 500 mmHg.ILM Peeling was performed without the use of dye. Subsequently phacoemulsification was realized through clear cornea and a 6,5 mm foldable acrylic lens was inserted into the bag without suturing the corneal incision. All eyes were assessed pre and post operatively at three months by OCT3 radial lines to evaluate the shape of membrane and retinal thickness. Diabetic, vascular or inflammatory membranes were excluded.

RESULTS:

Mean age was 73 with 38% females. Mean preoperative vision was 27/100 (0,59 LogMAR), mean postoperative vision was 44/100 (0,38 LogMAR) by three months. Mean macular retinal thickness measured with OCT 3 was 416 microns preoperatively and 332 microns postoperatively. No severe intraoperative complications were noted. One patient required conversion to 20 gauge due to insufficient ocular akinesis and illumination of macula and four
others needed conjunctival suture. Mean surgical time was 38 minutes and all eyes were observed for a minimum of 6 months. Intra ocular pressures remained stable throughout the postoperative course. We noticed no choroidal detachment and no detectable inflammation. No case of retinal detachment or endophthalmitis was recorded.

CONCLUSION:

Transconjonctival membrane peeling using 25 gauge instruments combined with sutureless phacoemulsification is a safe and effective alternative in macular surgery. It may hasten postoperative recovery by decreasing surgical time and postoperative inflammation while avoiding a second operation.