Up Next

27-gauge Vitrectomy for Rhegmatogenous Retinal Detachments

José Luis Vallejo-García, MD, Mario R. Romano, MD, PhD

Our case is a phakic 45 years old healthy man presented in his myopic right eye a macula-off rhegmatogenous retina detachment with a large superior horse shoe retinal tear. The preoperative best-corrected visual acuity was hand motion. Surgery is performed under retrobulbar block. The surgical procedure was performed with a 27-Gauge one-step Synergetics, system. The surgical parameters were as follows: fixed cut rate to 2500, proportional vacuum from 150 mmHg to 500 mmHg, intraocular pressure (IOP) at 30 mmHg. The retinal periphery is inspected for retinal breaks, and the break found is treated with cryotherapy, with no evidence of iatrogenic damage, and air-fluid exchange (AFX) is then performed. At the end of the surgical procedure, air-gas mixture (C3F8 12%) is injected. Although innovative and efficient, 27-gauge vitrectomy systems, supported by high cut rate and vacuum, still have met with some skepticism between the surgeons for the treatment of rhegmatogenous retinal detachments The main concern is related to the stiffness of the light and vitrectomy probe, the ability to adequately remove the vitreous gel throughout such small probe and the time required to perform a full vitrectomy. With the parameters used in this case, the flow-rate was still satisfactory for the surgeon, but we believe that the increase of the vacuum over 600 mmHg and the cut/rate could have further advantage in terms of safety, stability of vitreous cavity and speed of vitreous removal.

Posted: 7/10/2013