Langzeitergebnisse nach Pars-plana-Vitrektomie mit 25-Gauge-Technik

Abstract

The 25-gauge PPV technique appears to be effective and safe for the treatment of epiretinal membranes. The operation has low complication rates with respect to endophthalmitis or retinal detachment. The procedure has recently been further improved by using more stable instruments and better lighting.

Sutureless Vitrectomy

“…A rate of choroidal effusion of 3.8% was reported in one series of 140 eyes on day 1, but all cases had resolved without additional treatment by the end of the first post-operative week [17]. A similar incidence was reported by Lommatzsch et al [33], with 9 out of 329 eyes undergoing surgery for epiretinal membrane developing choroidal effusions, and in this series the leaking wounds were all treated by suturing. Retinopathy was reported in 2 cases with precipitous drops in IOP due to post-operative hypotony, in eyes which had raised IOP prior to surgery [34].…”

Safety of 20-Gauge Transconjunctival Sutureless Vitrectomy

“…The risk of endophthalmitis is believed to be high in sutureless vitrectomy because surface bacteria may enter through the incisions during the early postoperative period when the latter are still not healed [47,50,51,61,62]. We did not observe any case of endophthalmitis in our study.…”

“…In the bibliography, using 23- and 25-gauge transconjunctival sutureless vitrectomy, the need for suturing the sclerotomies at the end of surgery varies between 0% [6,19,56] and 7.1% [69] with the 25-gauge procedure, and between 0% [11,55] and 11.2% [50] with the 23-gauge procedure. In 20-gauge transconjunctival sutureless vitrectomy, when the sclera is entered at an acute angle of 10-15°, the need for suturing varies from 0% [15] to 6.8% [37].…”

“…In eyes filled with fluid the postoperative intraocular pressure is lower than that of the gas- or air-filled eyes, since the gas and the air seal the sclerotomies better thanks to their greater surface tension [49,50,51]. In our study, SF 6 was used as a tamponade agent in 60 eyes, C 3 F 8 in 21 eyes, air in 7 eyes, and silicone oil in 4 eyes, whereas in 87 eyes only fluid was introduced.…”

Primäre 25- und 23-Gauge-Vitrektomie in der Behandlung der rhegmatogenen Netzhautablösung – sinnvolle Ergänzung oder Schritt in die falsche Richtung?

“…Im Langzeitverlauf führt dies zu einer geringeren Vernarbung der Bindehaut und einer verbesserten Benetzung der Augenoberfläche. Die Patienten empfinden im Vergleich zur Buckelchirurgie oder einer 20-GaugeVitrektomie deutlich weniger postoperative Beschwerden wie etwa Schmerzen, Fremdkçrpergefühl, Bindehautrçtung, Lidschwellung oder Epiphora [23,27]. Die im Langzeitverlauf nach konventionellen Operationstechniken zu beobachtenden Benetzungsstçrungen [13] treten in der Praxis nach 25-und 23-Gauge seltener auf, auch wenn vergleichende wissenschaftliche Studien zum Langzeitverlauf noch ausstehen.…”