Skip to main content
SpringerLink
Log in

Advances in Vitrectomy

  • Chapter
  • First Online:
Current Advances in Ocular Surgery

Part of the book series: Current Practices in Ophthalmology ((CUPROP))

  • 247 Accesses

Abstract

In 1972, Robert Machemer was the first to introduce pars plana vitrectomy (PPV) with the development of the vitreous infusion suction cutter (VISC), a single port 17-gauge system with a cut rate less than 400 cuts per minute (CPM) [1, 2]. This monumental advancement changed the paradigm of the treatment of retinal disease due to the ability to manipulate vitreous and pre-retinal tissue in a closed, pressurized system. Fast-forward three decades, small gauge vitrectomy is routine in the management of vitreoretinal surgical disease. There have been several advancements that have made this possible. Gauge size has steadily decreased in size. Vitrectomy probes cut faster, maintain flow, and can cut in a bi-directional manner. Lighting and forceps designs have improved in quality and variety. Pump systems have been modified to optimize fluid dynamics. In this chapter, we will focus on these advances in vitrectomy and uncover what limitations spurred these developments.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 119.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 159.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Dhawan M, Dutta M, Sandhu PS, Singh SP. Evolution of vitreo retinal surgery. DOS Times 2013; 19 (3).

    Google Scholar 

  2. Charles S. The history of vitrectomy: innovation and evolution. Retina Today. 2008:27–9.

    Google Scholar 

  3. Machemer R, Hickingbotham D. The three-port microcannular system for closed vitrectomy. Am J Ophthalmol. 1985;100(4):590–2.

    Article  CAS  PubMed  Google Scholar 

  4. Arevalo JF, Berrocal MH, Arias JD, Banaee T. Minimally invasive vitreoretinal surgery: is sutureless vitrectomy the future of vitreoretinal surgery? J Ophthalmic Vis Res. 2011;6:136–44.

    PubMed  Google Scholar 

  5. Williams GA. 25-, 23-, or 20-gauge instrumentation for vitreous surgery? Eye (Lond). 2008;22:1263–6.

    Article  CAS  PubMed  Google Scholar 

  6. Fabian ID, Moisseiev J. Sutureless vitrectomy: evolution and current practices. Br J Ophthalmol. 2011;95:318–24.

    Article  PubMed  Google Scholar 

  7. Recchia FM, Scott IU, Brown GC, et al. Small-gauge pars plana vitrectomy: a report by the American Academy of ophthalmology. Ophthalmology. 2010;117:1851–7.

    Article  PubMed  Google Scholar 

  8. Kadonosono K, Yamakawa T, Uchio E, et al. Comparison of visual function after epiretinal membrane removal by 20-gauge and 25-gauge vitrectomy. Am J Ophthalmol. 2006;142:513–5.

    Article  PubMed  Google Scholar 

  9. Rizzo S, Genovesi-Ebert F, Murri S, 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;244:472–9.

    Article  PubMed  Google Scholar 

  10. Fujii GY, De Juan E Jr, Humayun MS, et al. A new 25-gauge instrument system for transconjunctival sutureless vitrectomy surgery. Ophthalmology. 2002;109:1807–12.

    Article  PubMed  Google Scholar 

  11. Shimada H, Nakashizuka H, Hattori T, Mori R, Mizutani Y, Yuzawa M. Incidence of endophthalmitis after 20- and 25-gauge vitrectomy causes and prevention. Ophthalmology. 2008;115(12):2215–20. https://doi.org/10.1016/j.ophtha.2008.07.015.

    Article  PubMed  Google Scholar 

  12. Acar N, Kapran Z, Unver YB, Altan T, Ozdogan S. Early postoperative hypotony after 25-gauge sutureless vitrectomy with straight incisions. Retina. 2008;28(4):545–52.

    Article  PubMed  Google Scholar 

  13. 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.

    Article  PubMed  Google Scholar 

  14. Ibarra MS, Hermel M, Prenner JL, et al. Longer-term outcomes of transconjunctival sutureless 25-gauge vitrectomy. Am J Ophthalmol. 2005;139:831–6.

    Article  PubMed  Google Scholar 

  15. Singh RP, Bando H, Brasil OF, Williams DR, Kaiser PK. Evaluation of wound closure using different incision techniques with 23-gauge and 25-gauge microincision vitrectomy systems. Retina. 2008;28(2):242–8. https://doi.org/10.1097/IAE.0b013e318156dea3.

    Article  PubMed  Google Scholar 

  16. Scott MN, Weng CY. The evolution of pars plana vitrectomy to 27-G microincision vitrectomy surgery. Int Ophthalmol Clin. 2016;56(4):97–111.

    Article  PubMed  Google Scholar 

  17. Miller DM, Riemann CD, Foster RE, Petersen MR. Primary repair of retinal detachment with 25-gauge pars plana vitrectomy. Retina. 2008;28(7):931–6. https://doi.org/10.1097/IAE.0b013e31816b313a.

    Article  PubMed  Google Scholar 

  18. Lai MM, Ruby AJ, Sarrafizadeh R, et al. Repair of primary rhegmatogenous retinal detachment using 25-gauge transconjunctival sutureless vitrectomy. Retina. 2008;28(5):729–34. https://doi.org/10.1097/IAE.0b013e318162b01c20.

    Article  PubMed  Google Scholar 

  19. Riemann CD, Miller DM, Foster RE, Petersen MR. Outcomes of transconjunctival sutureless 25-gauge vitrectomy with silicone oil infusion. Retina. 2007;27(3):296–303. https://doi.org/10.1097/01.iae.0000242761.74813.20.

    Article  PubMed  Google Scholar 

  20. Yonekawa Y, Thanos A, Abbey AM, et al. Hybrid 25- and 27-gauge vitrectomy for complex vitreoretinal surgery. Ophthlamic Surg Lasers Imaging Retina. 2016;47(4):352–5.

    Article  Google Scholar 

  21. Walter SD, Mahmoud TH. Hybrid-gauge and mixed-gauge microincisional vitrectomy surgery. Int Ophthalmol Clin. 2016;56(4):85–95.

    Article  PubMed  Google Scholar 

  22. Oellers P, Mahmoud TH. Surgery for proliferative diabetic retinopathy: new tips and tricks. J Ophthalmic Vis Res. 2016;11(1):93–9.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Yonekawa Y, Papakostas T. Hybrid 27-gauge vitrectomy. Retina Today. https://retinatoday.com/articles/2017-jan-feb/hybrid-27-gauge-vitrectomy. Accessed 09 Dec 2021.

  24. Zhu Y, Abulon DJK. Performance evaluation of 25-gauge 20,000 cpm vitrectomy probes: vitreous flow rates. Poster #5301 presented at EVER 2019; October 17–19, 2019; Nice, France.

    Google Scholar 

  25. Mitsui K, Kogo J, Takeda H, et al. Comparative study of 27-gauge vs. 25-gauge vitrectomy for epiretinal membrane. Eye. 2016;30:538–44.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  26. Chaves de Oliveira PR, Berger AR, Chow DR. Vitreoretinal instruments: vitrectomy cutters, endoillumination and wide-angle viewing systems. Int J Retina Vitreous. 2016;2:28.

    Article  Google Scholar 

  27. Mariotti C, Nicolai M, Saitta A, Orsini E, Viti F, Skrami E, Gesuita R, Reibaldi M, Giovannini A. Standard cut rate 25-gauge vitrectomy versus ultrahigh-speed 25-gauge system in core vitrectomy. A randomized clinical trial. Retina. 2016 Jul;36(7):1271–4. https://doi.org/10.1097/IAE.0000000000000924.

    Article  PubMed  Google Scholar 

  28. Pavlidis M. Two-dimensional cutting (TDC) vitrectome: in vivo flow assessment and prospective clinical study evaluating core vitrectomy efficiency versus standard vitrectome. J Ophthalmol. 2016;2016:3849316.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Castillo GF, Houston SKS. Technical advancements of surgical vitrectomy probes. https://us.alconscience.com/sites/g/files/rbvwei1736/files/pdf/Technical-Advancements-of-Surgical-Vitrectomy-Probes-US-VIT-2000003.pdf. Accessed 04 Jan 2022.

  30. Teixeira A, Chong LP, Matsuoka N, Arana L, Kerns R, Bhadri P, Humayun M. Vitreoretinal traction created by conventional cutters during vitrectomy. Ophthalmology. 2010;117(7):1387–92.e2. https://doi.org/10.1016/j.ophtha.2009.11.004. Epub 2010 Feb 21

    Article  PubMed  Google Scholar 

  31. Abulon D, Buboltz D, Charles S. Fluidics behavior during vitrectomy. Retina Surg. 2010:74–80.

    Google Scholar 

  32. Steel DH, Charles S. Vitrectomy fluidics. Ophthalmologica. 2011;226(Suppl 1):27–35. https://doi.org/10.1159/000328207. Epub 2011 Jul 22

    Article  PubMed  Google Scholar 

  33. DeBoer C, Fang S, Lima L, McCormick M, Bhadri P, Kerns R, Humayan M. Port geometry and its influence on vitrectomy. Retina. 2008;28(8):1061–7. 10.1097/IAE.ob013e3181840b64

    Article  PubMed  Google Scholar 

  34. Stalmans PW. Peristaltic pumps are better than venturi: fact. Presentation at American Academy of ophthalmology retina subspecialty day; Oct 17, 2014; Chicago, IL.

    Google Scholar 

  35. Ducournau D, Warren KA, Stalmans P, et al. EVA: a state-of-the-art surgical system for phaco-vitrectomy. Retina Today. 2013;May/June Suppl:6–9.

    Google Scholar 

  36. de Oliveira PR, Berger AR, Chow DR. Vitreoretinal instruments: vitrectomy cutters, endoillumination and wide-angle viewing systems. Int J Retina Vitreous. 2016;2:28. Published 2016 Dec 5. https://doi.org/10.1186/s40942-016-0052-9.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Ophthalmology, NYU Langone Health, New York, NY, USA

    Saagar Pandit, Yasha Modi & Nitish Mehta

Authors
  1. Saagar Pandit
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Yasha Modi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Nitish Mehta
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Nitish Mehta .

Editor information

Editors and Affiliations

  1. Stein Eye Institute, University of California, Los Angeles, Los Angeles, CA, USA

    Edmund Tsui

  2. Stein Eye Institute, University of California, Los Angeles, Los Angeles, CA, USA

    Simon S. M. Fung

  3. Department of Ophthalmology, Massachusetts Eye and Ear Harvard Medical School, Boston, MA, USA

    Rohan Bir Singh

Rights and permissions

Reprints and permissions

Copyright information

© 2023 The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd.

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Pandit, S., Modi, Y., Mehta, N. (2023). Advances in Vitrectomy. In: Tsui, E., Fung, S.S.M., Singh, R.B. (eds) Current Advances in Ocular Surgery. Current Practices in Ophthalmology. Springer, Singapore. https://doi.org/10.1007/978-981-99-1661-0_17

Download citation

  • DOI: https://doi.org/10.1007/978-981-99-1661-0_17

  • Published:

  • Publisher Name: Springer, Singapore

  • Print ISBN: 978-981-99-1660-3

  • Online ISBN: 978-981-99-1661-0

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation