Search
Search
M A Awan, MD, Z R Koshy, MD
Show Description +
Z R Koshy and M A Awan from the Ayr Hospital in Glasglow demonstrate a 20-gauge sutureless transconjunctival vitrectomy technique. The authors cover creation of the entry sites and simultaneous closure.
Posted: 8/08/2011
M A Awan, MD, Z R Koshy, MD
Z R Koshy and M A Awan from the Ayr Hospital in Glasglow demonstrate a 20-gauge sutureless transconjunctival vitrectomy technique. The authors cover creation of the entry sites and simultaneous closure.
Posted: 8/08/2011
![[2019] Amniotic Membrane Placement for Repair of Recurrent Macular Hole](https://d33x7gwyb2b5z6.cloudfront.net/eyetube/thumbs/gldaw.jpg?auto=compress,format&w=180)
Please log in to leave a comment.
Comments
Just Now
balaji ramanathan
14 years ago
Very good modification.But a single suture through the conj and sclera will be more secure.The eye becomes quite down as rapidly and the vicryl dissolves in a week.Should we be so focused on sutureless as our anterior segment colleges!! again great modification Dr koshy and Dr awan good thinking
zachariah koshy
14 years ago
Thank you for your comments which have valid reasoning. We have recently published our results from a series of over 100 patients in the BJO in which their was no instance of post -op hypotony (<8mmHg). We believe this is so because of the valve shaped construction of the wound and the simultaenous closure of wounds to allow the IOP to rise and thus activate the valve mechanism. The wounds are funnel shaped to precisely address your point on difficulty in finding the sclerotomies as the wider mouth allows easy insertion of instruments. We use cefuroxime for subconjunctival injections the same as that used for intracameral injections, with adequate conjunctival cover of the wounds on the 1st post operative day. We have used this technique for the complete spectrum of vitreoretinal pathology except where silicone oil was used. The particular case illustrated in the video is that of a young diabetic with proliferative retinopathy and tractional RD.
SHALABH SINHA
14 years ago
I have certain reservations about this procedure. The 20 - 19 gauge wounds are not properly covered by conjunctiva. Using antibiotics subconjunctivally with such close proximity to the wounds risks the drug reaching behind and resulting macular toxicity. The chances of hypotony are very much present with such large wounds. You did not show which case you did, but I guess a very quick one which requires hardly any instruments. I ask this because just like routine 20 G cases finding the sclerotomy sometimes is difficult with the microscope light off. The wounds can deform with multiple instrument exchanges and may not close well at the end. Plus this is not exactly transconjunctival, if you do open up the conjunctiva. This may be aptly called "valvular" 20 G vitrectomy. The benefits of transconjunctival vitrectomy relies a lot on the cannula, which provides the protection at the vitreous base, presence of valves maintains the IOP etc etc.