A new infusion sustainer that stabilizes perfusion during sutureless 25-gauge vitrectomy

To stabilize perfusion during sutureless 25-gauge (25G) vitrectomy, we designed an infusion sustainer and examined its usefulness. A reusable infusion sustainer was constructed by soldering a piece of metal wire to a metal paper clip and curling the two ends of the wire. For use, the sustainer was clipped onto the lip retractor, and the infusion line and chandelier fiber were passed through the wire loops. 25G vitrectomy was conducted in three porcine eyes, with insertion of a tonometer to monitor intraocular pressure (IOP). The relation between infusion port direction and IOP was examined. In a clinical study, 30 eyes that underwent 25G vitrectomy using the infusion sustainer and 30 eyes without using the infusion sustainer were compared for IOP maintenance and complications. In the porcine eye, after angled incision, the infusion tip was pointing toward the basal vitreous on the anterior side of the eyeball. Under these conditions, vitreous resection was accompanied by IOP lowering. When the infusion tip was moved so as to be directed toward the central vitreous, IOP was maintained. In the clinical study, among the eyes undergoing vitrectomy without the infusion sustainer, IOP decreased during operation in 30 eyes, and infusion fluid or air flowed into the anterior chamber in four eyes. In the 30 eyes in which the sustainer was used, no IOP lowering and no infusion fluid or air flow into the anterior chamber were detected, due to stabilization of the infusion port. Use of the infusion sustainer orients the infusion port toward the central vitreous, stabilizes IOP and prevents flow of infusion fluid or air into the anterior chamber. This infusion sustainer is useful to perform sutureless 25G vitrectomy safely.