Technical development in 25-gauge pars plana
vitrectomy
Stefan Nikolic1, F. Koch2, L.-O. Hattenbach22 (1Hannover, 2Frankfurt/Main)
Introduction: In 2003,
the 25-gauge system for pars plana vitrectomy was introduced into the
German market. Meanwhile, the systems produced by various manufacturers
underwent several technical changes. Initial problems with low light output,
difficult insertion of the trocar or the high flexibility of instruments
have been resolved to a great extend. In the meantime different systems
and system components are available, which offer the same equipment options
for 20-gauge as for 25-gauge vitrectomies. New production technologies
clearly supported these developments.
Development: The development of the 2nd generation trocars eliminated
the initial difficulties of insertion. New illumination technologies with
improved light field brightness offer nearly all possibilities for intravitreal
illumination. The flexibility of the instruments remains a further challenge.
There is only a limited possibility for a stable rotation of the bulbus
as it is performed routinely during a 20-gauge PPV. For the use of chandelier
illumination or direct fundus illumination via microscope and binocular
indirect ophthalmoscope this problem was solved by the development of
a bulbus stabilizer with simultaneous indentation or ILM-peeling function.
We report on our experiences in cases of extended indications, using different
systems for 25-gauge pars plana vitrectomy.
Conclusion: Due to technical development of the equipment, today, for
selected indications, the intra- and postoperative complications are comparable
for 25-gauge and 20-gauge vitrectomy.