25 gauge vitrectomy - the “second generation”
William V. Aldred (Pensacola)
Twenty five gauge vitrectomy
continues to attract attention in discussions on posterior segment
surgery. Many surgeons have embraced this technique based upon their success
with the “first
generation” instrumentation. Others, however, remain hesitant to
“convert” their practices. Some have reported returning to
20g surgery because of engineering issues or personal preference. Continuing
controversy therefore exists as to what constitutes the “best approach”
to surgically entering the vitreous cavity. This presentation can be considered
a sequel to my talk at the 2003 VRS entitled “The Learning Curve
of 25g Vitrectomy”. This community based surgeon summarizes his
experience with the recently introduced portfolio of instruments and corresponding
techniques that collectively can be termed “second generation 25g
vitrectomy”. Herein I will discuss specific upgrades to a variety
of instruments, and the application of said instruments in selected cases.
Instruments that have stood the “test of time” will also be
reviewed. Engineering and surgical issues that remain unresolved will
also be noted. Changes which have evolved in the procedure due to these
“second generation” upgrades, and “tips” for achieving
maximum success (and avoidance of complications) will be emphasized. Heavy
utilization of mini-video clips is intended to enhance the message.