Abstract
Purpose of Review
This paper aims to provide an overview of the currents aspects involving 27-gauge vitrectomy published on the PubMed directory.
Recent Findings
Almost 15 years have passed since the microincision vitrectomy system was introduced. The idea of removing vitreous through a smaller aperture has become a reality and is widely adopted among surgeons. Although not completely accepted, the use of 27-gauge systems has shown encouraging results. Newer vitrectomy platforms and cutter designs have tried to associate high-performance, smaller instruments with better outcomes. Consequently, the indications for 27-gauge vitrectomy have broadened during the last few years.
Summary
Twenty-seven-gauge vitrectomy seems to be safe and feasible in a variety of vitreoretinal scenarios.
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References
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
Machemer R, Buettner H, Norton EW, Parel JM. Vitrectomy: a pars plana approach. Trans Am Acad Ophthalmol Otolaryngol. 1971;75(4):813–20.
Charles S. The history of vitrectomy: innovation and evolution. Retina Today. 2008; September/October:27–9.
Fujii GY, De Juan Jr E, Humayun MS, Chang TS, Pieramici DJ, Barnes A, et al. Initial experience using the transconjunctival sutureless vitrectomy system for vitreoretinal surgery. Ophthalmology. 2002;109(10):1814–20.
Fujii GY, De Juan Jr E, Humayun MS, Pieramici DJ, Chang TS, Awh C, et al. A new 25-gauge instrument system for transconjunctival sutureless vitrectomy surgery. Ophthalmology. 2002;109(10):1807–12. discussion 13
Eckardt C. Transconjunctival sutureless 23-gauge vitrectomy. Retina. 2005;25(2):208–11.
Park DH, Shin JP, Kim SY. Surgically induced astigmatism in combined phacoemulsification and vitrectomy; 23-gauge transconjunctival sutureless vitrectomy versus 20-gauge standard vitrectomy. Graefes Arch Clin Exp Ophthalmol. 2009;247(10):1331–7. doi:10.1007/s00417-009-1109-3.
Kellner L, Wimpissinger B, Stolba U, Brannath W, Binder S. 25-gauge vs 20-gauge system for pars plana vitrectomy: a prospective randomised clinical trial. Br J Ophthalmol. 2007;91(7):945–8. doi:10.1136/bjo.2006.106799.
Kadonosono K, Yamakawa T, Uchio E, Yanagi Y, Tamaki Y, Araie M. Comparison of visual function after epiretinal membrane removal by 20-gauge and 25-gauge vitrectomy. Am J Ophthalmol. 2006;142(3):513–5. doi:10.1016/j.ajo.2006.03.060.
Rizzo S, Genovesi-Ebert F, Murri S, Belting C, Vento A, Cresti F, et al. 25-gauge, sutureless vitrectomy and standard 20-gauge pars plana vitrectomy in idiopathic epiretinal membrane surgery: a comparative pilot study. Graefes Arch Clin Exp Ophthalmol. 2006;244(4):472–9. doi:10.1007/s00417-005-0173-6.
Recchia FM, Scott IU, Brown GC, Brown MM, Ho AC, Ip MS. Small-gauge pars plana vitrectomy: a report by the American Academy of Ophthalmology. Ophthalmology. 2010;117(9):1851–7. doi:10.1016/j.ophtha.2010.06.014.
Romero P, Salvat M, Almena M, Baget M, Mendez I. Experience with 25-gauge transconjunctival vitrectomy compared to a 20-gauge system. Analysis of 132 cases. J Fr Ophtalmol. 2006;29(9):1025–32.
Oshima Y, Wakabayashi T, Sato T, Ohji M, Tano Y. A 27-gauge instrument system for transconjunctival sutureless microincision vitrectomy surgery. Ophthalmology. 2010;117(1):93–102. e2 doi:10.1016/j.ophtha.2009.06.043.
Oshima Y, Awh CC, Tano Y. Self-retaining 27-gauge transconjunctival chandelier endoillumination for panoramic viewing during vitreous surgery. Am J Ophthalmol. 2007;143(1):166–7. doi:10.1016/j.ajo.2006.07.051.
Steel DH, Charles S. Vitrectomy fluidics. Ophthalmologica. 2011;226(Suppl 1):27–35. doi:10.1159/000328207.
Osawa S, Oshima Y. Innovations in 27-gauge vitrectomy for sutureless microincision vitrectomy surgery. Retina Today. 2014;July:42–5.
Charles S. Fluidics and cutter dynamics. Dev Ophthalmol. 2014;54:31–7. doi:10.1159/000360446.
Teixeira A, Chong LP, Matsuoka N, Arana L, Kerns R, Bhadri P, et al. Vitreoretinal traction created by conventional cutters during vitrectomy. Ophthalmology. 2010;117(7):1387–92. e2 doi:10.1016/j.ophtha.2009.11.004.
Osawa S, Oshima Y. 27-gauge vitrectomy. Dev Ophthalmol. 2014;54:54–62. doi:10.1159/000360449.
Abulon DJ, Buboltz DC. Porcine vitreous flow behavior during high-speed vitrectomy up to 7500 cuts per minute. Transl Vis Sci Technol. 2016;5(1):7. doi:10.1167/tvst.5.1.7.
Stalmans P. Enhancing visual acuity. Dev Ophthalmol. 2014;54:23–30. doi:10.1159/000360445.
• Pavlidis M. Two-dimensional cutting (TDC) vitrectome: in vitro flow assessment and prospective clinical study evaluating core vitrectomy efficiency versus standard vitrectome. J Ophthalmol. 2016;2016:3849316. doi:10.1155/2016/3849316. This study provided information on a new blade design, capable of cut rates of up to 16.000 cuts per minute, and that is already commercially available in 27-gauge sizes
Rizzo S, Barca F, Caporossi T, Mariotti C. Twenty-seven-gauge vitrectomy for various vitreoretinal diseases. Retina. 2015;35(6):1273–8. doi:10.1097/IAE.0000000000000545.
•• Khan MA, Shahlaee A, Toussaint B, Hsu J, Sivalingam A, Dugel PU et al. Outcomes of 27 gauge microincision vitrectomy surgery for posterior segment disease. Am J Ophthalmol. 2016; 161:36–43 e1–2. doi:10.1016/j.ajo.2015.09.024. This is a recent, multicenter study that provided the initial experience, clinical outcomes, and safety profile of 27-gauge pars plana vitrectomy in eyes with posterior segment disease.
Chow DR. The evolution of endoillumination. Dev Ophthalmol. 2014;54:77–86. doi:10.1159/000360452.
Gupta OP, Weichel ED, Regillo CD, Fineman MS, Kaiser RS, Ho AC, et al. Postoperative complications associated with 25-gauge pars plana vitrectomy. Ophthalmic Surg Lasers Imaging. 2007;38(4):270–5.
Amato JE, Akduman L. Incidence of complications in 25-gauge transconjunctival sutureless vitrectomy based on the surgical indications. Ophthalmic Surg Lasers Imaging. 2007;38(2):100–2.
Byeon SH, Lew YJ, Kim M, Kwon OW. Wound leakage and hypotony after 25-gauge sutureless vitrectomy: factors affecting postoperative intraocular pressure. Ophthalmic Surg Lasers Imaging. 2008;39(2):94–9.
Woo SJ, Park KH, Hwang JM, Kim JH, Yu YS, Chung H. Risk factors associated with sclerotomy leakage and postoperative hypotony after 23-gauge transconjunctival sutureless vitrectomy. Retina. 2009;29(4):456–63. doi:10.1097/IAE.0b013e318195cb28.
Chieh JJ, Rogers AH, Wiegand TW, Baumal CR, Reichel E, Duker JS. Short-term safety of 23-gauge single-step transconjunctival vitrectomy surgery. Retina. 2009;29(10):1486–90. doi:10.1097/IAE.0b013e3181aa8e6c.
Mitsui K, Kogo J, Takeda H, Shiono A, Sasaki H, Munemasa Y, et al. Comparative study of 27-gauge vs 25-gauge vitrectomy for epiretinal membrane. Eye (Lond). 2016;30(4):538–44. doi:10.1038/eye.2015.275.
Gupta OP, Ho AC, Kaiser PK, Regillo CD, Chen S, Dyer DS, et al. Short-term outcomes of 23-gauge pars plana vitrectomy. Am J Ophthalmol. 2008;146(2):193–7. doi:10.1016/j.ajo.2008.04.010.
Coppola M, La Spina C, Querques G, Bandello F. Epiretinal membrane peeling without forceps: an alternative use of the 27-gauge vitrectomy probe. Retina. 2016;36(10):2029–30. doi:10.1097/IAE.0000000000001173.
Yonekawa Y, Thanos A, Abbey AM, Thomas BJ, Todorich B, Faia LJ, et al. Hybrid 25- and 27-gauge vitrectomy for complex vitreoretinal surgery. Ophthalmic Surg Lasers Imaging Retina. 2016;47(4):352–5. doi:10.3928/23258160-20160324-08.
Pavlidis M, Korber N, Hohn F. Surgical and functional results of 27-gauge vitrectomy combined with coaxial 1.8 mm microincision cataract surgery: a consecutive case series. Retina. 2016;36(11):2093–100. doi:10.1097/IAE.0000000000001052.
Romano MR, Scotti F, Vinciguerra P. 27-gauge vitrectomy for primary rhegmatogenous retinal detachment: is it feasible? Ann Acad Med Singap. 2015;44(5):185–7.
Todorich B, Thanos A, Woodward MA, Wolfe JD. Sutureless intrascleral fixation of secondary intraocular lens using 27-gauge vitrectomy system. Ophthalmic Surg Lasers Imaging Retina. 2016;47(4):376–9. doi:10.3928/23258160-20160324-14.
Watanabe A, Tsuzuki A, Arai K, Gekka T, Tsuneoka H. Treatment of dropped nucleus with a 27-gauge twin duty cycle vitreous cutter. Case Rep Ophthalmol. 2016;7(1):44–8. doi:10.1159/000443721.
Toygar O, Mi CW, Miller DM, Riemann CD. Outcomes of transconjunctival sutureless 27-gauge vitrectomy with silicone oil infusion. Graefes Arch Clin Exp Ophthalmol. 2016;254(11):2111–8. doi:10.1007/s00417-016-3355-5.
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David Chow and Paulo Oliveira declare no conflict of interest.
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de Oliveira, P.R.C., Chow, D.R. Twenty-Seven-Gauge Vitrectomy. Curr Ophthalmol Rep 5, 67–72 (2017). https://doi.org/10.1007/s40135-017-0122-7
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DOI: https://doi.org/10.1007/s40135-017-0122-7