'Mini-gauge' pars plana vitrectomy: 'inside-out view' with the GRIN solid rod endoscope

Area of Science:

• Ophthalmology
• Surgical Technology
• Minimally Invasive Surgery

Background:

• Pars plana vitrectomy is a common ophthalmic surgical procedure.
• Advancements in surgical instrumentation have led to the development of 'mini-gauge' systems (23- and 25-gauge).
• Understanding the nuances of these smaller gauge systems is crucial for optimizing surgical outcomes.

Purpose of the Study:

• To stimulate discussion regarding the use of mini-gauge pars plana vitrectomy.
• To provide detailed endoscopic observations of 23- and 25-gauge cannula insertion and intraocular procedures.
• To identify potential complications and effective management strategies during mini-gauge vitrectomy.

Main Methods:

• Gradient index high-resolution endoscopy was employed to visualize the vitreous cavity during pars plana interventions.
• A total of 66 pars plana interventions, involving nearly 200 cannulas, were recorded.
• Observations were made using both the endoscope and standard microscopy.

Main Results:

• Five key 'inside-out' observations were documented via endoscopy.
• Minimal trocar rotation is needed for safe cannula implantation; excessive rotation can cause adverse effects.
• Vitreous incarceration during cannula insertion leads to significant anterior-posterior vitreous traction.
• Intraocular cleaning with a suction cutter effectively releases traction without increasing hypotony.
• External manipulation of the sclerotomy site increases the risk of bleeding.

Conclusions:

• Endoscopic insights can significantly aid surgeons contemplating a transition to mini-gauge pars plana vitrectomy systems.
• Careful attention to cannula implantation technique and intraocular port cleaning is essential for minimizing complications.
• Minimally invasive techniques, when properly executed, offer favorable outcomes in vitreoretinal surgery.