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25-Gauge vitrectomy for paediatric vitreoretinal conditions
C R Gonzales1, S Singh, S D Schwartz
1Retina and Vitreous Center, Ashland, Oregon, USA. cgonzales@retinaandvitreous.com
Insights
This study shows that 25-gauge vitrectomy is a feasible and safe surgical option for pediatric vitreoretinal conditions. A modified sutured technique is recommended for infants to prevent postoperative hypotony.
Area of Science:
- Ophthalmology
- Pediatric Surgery
- Retinal Surgery
Background:
- Pediatric vitreoretinal surgery presents unique challenges due to the small size of the eye.
- Minimally invasive techniques are desirable to reduce complications in pediatric patients.
Purpose of the Study:
- To assess the feasibility and safety of 25-gauge vitrectomy in children for various vitreoretinal conditions.
- To compare outcomes between standard and modified surgical approaches in different age groups.
Main Methods:
- Retrospective analysis of 56 eyes from 49 children (≤18 years) undergoing 25-gauge vitrectomy over 5 years.
- Two techniques were employed: a modified sutured approach for infants (<1 year) and a transconjunctival approach for older children.
- Data on intraoperative and postoperative complications were collected and analyzed.
Main Results:
- No cases of endophthalmitis, wound leaks, or hypotony requiring treatment were reported.
- Minor intraoperative events included conversions to 20-gauge and bleeding.
- Postoperative complications included cataract, retinal detachment, and vitreous hemorrhage, often in eyes with complex pathology.
Conclusions:
- 25-gauge vitrectomy is a viable and safe technique for pediatric vitreoretinal surgery, offering good access to small ocular spaces.
- A modified sutured technique is recommended for infants to mitigate the risk of postoperative hypotony.
Unlabelled:
This is a retrospective study of 56 eyes of 49 children undergoing vitrectomy with 25-gauge instrumentation. There were no cases of endophthalmitis, wound leaks or hypotony requiring treatment. A modified approach in which the conjunctiva and sclera is sutured was used for young babies requiring a pars plicata approach.
Objective:
To evaluate the feasibility and safety of 25-gauge vitrectomy for various vitreoretinal indications in the paediatric population.
Methods:
Consecutive patients aged 18 years or less undergoing vitrectomy for various vitreoretinal indications over a 5-year period were studied retrospectively. Two different surgical techniques were used: a modified 25-gauge approach in which the sclerotomies and conjunctiva were sutured as described previously for most children under the age of 1 year, and a transconjunctival 25-gauge approach for older children
Results:
56 eyes in 49 children (16 girls and 33 boys) were included. Intraoperative unplanned events or complications included: conversion to 20-gauge vitrectomy (four), conversion of one port to a 20-gauge sclerotomy (two), suspected lens damage (one) and intraoperative bleeding from a vascular ridge (one). Postoperative complications included cataract (five), rhegmatogenous retinal detachment (four) and vitreous haemorrhage (three). The four retinal detachments were either recurrent or occurred in eyes with complex ocular pathology and were not felt to be related to the surgical technique. There were no cases of postoperative hypotony requiring intervention, choroidal detachment, endophthalmitis or sclerotomy-related retinal breaks.
Conclusions:
25-gauge vitreoretinal techniques can be used in various paediatric vitreoretinal conditions and facilitate easy access to small spaces in the paediatric eye. To avoid postoperative hypotony, a modified technique is recommended for younger babies in which the conjunctiva and sclera is sutured.
