27-Gauge Vitrectomy: Minimal Sclerotomies for Maximal by Ulrich Spandau, Mitrofanis Pavlidis

By Ulrich Spandau, Mitrofanis Pavlidis

This ebook presents step by step directions on how you can function with 27G instrumentation in a variety of surgical symptoms, together with vitreous floaters, macular holes, dropped nucleus, retinal detachment, diabetic retinopathy, submacular hemorrhage, retinopathy of prematurity and lots more and plenty trauma. All surgical procedures are approached in cookbook type, with preliminary assurance of the “ingredients” (devices and tools) after which meticulous description of guidance and function with assisting images, drawings and video clips. furthermore, the diversities and merits compared to 23G and 25G vitrectomy are highlighted.

Small-gauge vitrectomy has substantially replaced the ways that vitrectomy is played. 27G vitrectomy is the latest and most enjoyable improvement in small-gauge vitrectomy. The therapeutic time is quicker however the small diameter prolongs the length of surgical procedure. This problem has been conquer with robust new vitrectomy machines and innovative vitreous cutters with slicing blades making 27G vitrectomy as quickly as 25G. This new apparatus has extended the symptoms for 27G surgical procedures immensely from detachment surgical procedure to retinopathy of prematurity and the arrival of recent tools may perhaps make 27G the most efficient sooner or later. This publication, written through authors with large adventure in 27G vitrectomy, will let surgeons to completely take advantage of its advantages.

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5 times slower than in 23G. This physical obstacle has been overcome with powerful vitrectomy machines and novel vitreous cutters with double cutting frequency and permanent flow. The novel double-cut vitrector has made 27G to a fierce competitor of 23G. 6 1 Introduction to 27G Fig. 3 Section through the sclera after insertion and extraction of a 27G trocar (DORC). Excellent sealing of sclerotomy Fig. 4 Begin of vitrectomy. The high pressure infusion line is in place. 3 × less flow than 25 G Differences Between 23G, 25G and 27G If the performance of a 23G cutter is 100 %, then a 25G cutter has approximately 30 % less performance and a 27G cutter approximately 30 % less performance (Fig.

1 Backflush Instrument (=Charles Flute Needle) (Figs. 35) Indication: For aspiration of fluid and pressure control. It aspirates in fluid by capillary force and pressure difference. 6 Miscellaneous Fig. 41 A 10 ml silicone oil syringe which is filled with silicone oil. DORC Fig. 42 A 27G cannula is attached to the syringe for silicone oil injection. VFI04 Fig. 43 Silicone oil removal with plastic pipe for 20G–27G (DORC) Fig. 44 Vicryl 8-0 suture for suturing of conjunctiva and sclerotomies 37 38 2 Optimal Visualization, Optimal Instruments and Optimal Technique Fig.

The disadvantage of the trocar compared to the usual sclerotomy is the excessive leakage of fluid through the trocars. Valve Against No Valve The valve on the trocar solves this problem. The valve keeps the globe watertight. You can remove the infusion and the globe is still normotensive. Valves have more advantages. Valves prevent incarceration of vitreous into the trocars; less fluid is infused; valves build up a higher intraocular pressure, which is useful during a fluid–air exchange or removal of a preretinal oil bubble; and you do not need to work with plugs.

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