A modified approach to actively remove high viscosity silicone oil through 23-gauge cannula

AIM：To report a simple approach to actively remove high viscosity silicone oil through a 23-gauge cannula via pars plana.METHODS：Forty-eight eyes of 48 patients underwent silicone oil（5700 centistokes） removal（SOR） were enrolled.A section of blood transfusion set was prepared to connect a standard 23-gauge cannula and vitrectomy machine.Silicone oil was removed with suction of500-mm Hg vacuum through the cannula.Main outcome measures were SOR duration,number of sutured sites,intraocular pressure（IOP）,best-corrected visual acuity（BCVA）,and complications.RESULTS：Silicone oil was successfully removed in all cases.The mean SOR time was 5.70±0.85 min.Nine eyes（18.75%） needed suture partial sclerotomies.No intraoperative complications were noted.Transient hypotony（≤8 mm Hg） was seen in 3 eyes（6.25%） on postoperative day 1,but all resolved within 1wk.Retinal reattachment was achieved in all cases and no other postoperative complications were noted during 3-month following-up.BCVA at the final visit improved or stabilized in all patients comparing to the preoperative level.CONCLUSION：Active removal of high viscosity silicone oil through a 23-gauge instrument cannula jointed with blood transfusion set is a practical and reliable technique when considering two sides of efficacy and safety.

A sutureless technique for securing leaking sclerotomies with viscoelastic substances in 23-gauge microincision vitrectomy surgery

AIM:To introduce and evaluate the clinical efficacy of a new technique,the use of viscoelastic substances(VS)to close leaking sclerotomy in 23G microincision vitrectomy,and to observe its effect on the visual acuity and intraocular pressure(IOP)of patients.METHODS:Patients who underwent 23G vitrectomy in Ningbo Eye Hospital before the use of VS technique(June 2019 to September 2020)and after the use of VS technique(October 2020 to December 2021)were selected as the subjects of this study.The above cases underwent operation by the same surgeon and were retrospectively analyzed.VS technique was used as the alternative to suturing,in which a small amount of VS was injected at the leaking sclerotomy and then gently massaged to confirm leaking sclerotomy closure.RESULTS:A total of 174 eyes were covered in the study,including 84 eyes in the control group(before the use of VS technique)and 90 eyes in the VS technique group.The number of eyes that needed to be sutured decreased considerably from 42.9%in the control group to 3.3%in the VS technique group,and the proportion of subconjunctival hemorrhage at 1-2d after surgery decreased remarkably from 35.7%in the control group to 2.2%in the VS technique group.No substantial differences in the incidence of mean IOP and low IOP were found between 1-2 and 3-20d after surgery in the VS technique group.No major complications associated with VS technique were identified during the study.CONCLUSION:In 23G microincision vitrectomy,VS technique is a safe,simple,and effective method to close leaking sclerotomy.

Clinical presentation of a mixed 23-gauge infusion and 20-gauge pars plana technique for active silicone oil removal

AIM: To present with a clinical case series of a mixed 23-gauge infusion and 20-gauge pars plena technique for 5,700-centipoise silicone oil removal (SOR), and to discuss its efficacy and safety. METHODS: This is a retrospective, non-randomized controlled study. We performed SOR with 23-gauge infusion and 20-gauge active suction technique on 29 patients 29 eyes from April to October, 2011 (mixed group). During the surgeries, a 23-gauge sclerotomy was made for infusion and a 20-gauge sclerotomy was used for active silicone oil suction. Anterior segment optical coherence tomography (OCT) was applied for 23-gauge sclerotomy analysis 1 day post-operation. Traditional 20-gauge SOR was performed on another consecutive 29 patients 29 eyes, the control group (20G group). RESULTS: There were 2 eyes (6.9%) in mixed group and 5 eyes (17.2%) in 20G group which had recurrent retinal detachment after surgery. Hopytony (IOP <= 6mmHg) occurred in 8 eyes (27.6%) of mixed group and in 10 eyes (34.5%) of 20G group post-operation, but all of them recovered to the normal level finally. There were no statistical significant differences. Final visual acuity was significantly increased after surgery in both groups. Anterior segment OCT images were acquired from 13 eyes of mixed group, and all of them had a proper wound apposition. But local ciliary detachment was found in 9 eyes (69%). It was hard to define the OCT image of the sclerotomies and ciliary body because of the serious conjunctival hemorrhages and chemosis in 20G group. CONCLUSION: This mixed technique is a convenient and effective way to remove high viscosity silicone oil. Compared with traditional 20-gauge SOR, it does not increase the risk of post-operative complications and has less conjunctival reactions.. Transient postoperative hypotony is common for this procedure and subclinical ciliochoroidal detachment is a probable cause.

Ahmed valve implantation for neovascular glaucoma after 23-gauge vitrectomy in eyes with proliferative diabetic retinopathy

·AIM: To report on the outcome of Ahmed glaucoma valve (AGV) implantation for the management of neovascular glaucoma (NVG) after 23 -gauge vitrectomy for proliferative diabetic retinopathy (PDR). ·METHODS: Twelve medically uncontrolled NVG with earlier 23 -gauge vitrectomy for PDR underwent AGV implantation. The control of intraocular pressure (IOP), preoperative and postoperative best -corrected visual acuity, the development of intraoperative and postoperative complications were evaluated during the follow-up. ·RESULTS: The mean follow-up was 15.4±4.3 months (9-23 months). Mean preoperative IOP was 49.4±5.1mmHg and mean postoperative IOP at the last visit was 17.5 ± 1.6mmHg. The control of IOP was achieved at the final follow -up visits in all patients, however, 8 of 12 patients still needed anti-glaucoma medication (mean number of medications, 0.8±0.7). The visual acuity improved in nine eyes, and the visual acuity unchanged in three eyes at the final follow -up visits. The complications that occurred were minor hyphema in three eyes, choroid detachment in two eyes, and the minor hyphema and choroid detachments were reabsorbed without any surgical intervention. ·CONCLUSION: AGV implantation is a safe and effective procedure that enables successful IOP control and vision preservation in the NVG patients with the history of earlier 23-gauge vitrectomy for PDR.·

Primary 23-gauge vitreoretinal surgery for rhegmatogenous retinal detachment

AIM: To report the effectiveness and safety of primary 23-Gauge (G) vitreoretinal surgery for rhegmatogenous retinal detachment (RRD). · METHODS: In this retrospective study, 49 eyes of 49 consecutive patients who underwent primary 23-G transconjunctival sutureless vitrectomy (TSV) for RRD between January 2007 and July 2009 at our institution were evaluated. · RESULTS: Mean follow-up time was 8.9±7.7 months (1-28 months). Retinal reattachment was achieved with a single operation in 47(95.9%) of 49 eyes. In two eyes (4.1%), retinal redetachment due to new breaks was successfully treated with reoperation using the 23-G TSV system. Mean logMAR visual acuity was 2.01±0.47 preoperatively and 1.3±0.5 postoperatively (P <0.001, Paired t -test). Mean preoperative intraocular pressure (IOP) was 14.1±2.8mmHg. Mean postoperative IOP was 12.3±3.6mmHg at 1 day, 13.1±2.1mmHg at 1 week, 14.3±2.2mmHg at 1 month. Iatrogenic peripheral retinal break was observed in 1 eye(2.0%) intraoperatively. No sutures were required to close the scleral or conjunctival openings, and no eyes required convertion of surgery to 20-G vitrectomy. · CONCLUSION: Primary 23-G TSV system was observed to be effective and safe in the treatment of RRD.

Removal of intraocular foreign body in anterior chamber angle with prism contact lens and 23-gauge foreign body forceps

AIM：To introduce a novel approach in removal of anterior chamber angle foreign body（ACFB） using a prism contact lens and 23-gauge foreign body forceps.METHODS：Data of 42 eyes of 42 patients who had undergone removal of ACFB using a prism contact lens and 23-gauge foreign body forceps from January 2008 to October 2013 were collected and analyzed. Twenty eyes in group A received the conventional approach by using toothed forceps through corneal limbus incision, and 22 eyes in group B underwent the novel method through the opposite corneal limbus incision. RESULTS：The success rate of ACFB once removal was 75%（15/20） in group A, and 100%（22/22） in group B. The average operation time of group A was significantly longer compared with group B（34.9±9.88 min vs 22.13±8.85min; P〈0.05）. The average size of corneal limbus incision in group A was significantly larger than that of group B（4.85±1.89 mm vs 3.95±1.17 mm; P〈0.05）. The corneal limbus incision suturing were conducted in all eyes in group A, and only 5 eyes in group B. CONCLUSION：Removal of ACFB using a prism contact lens and 23-gauge foreign body forceps is a safer, more effective, and convenient technique compared with the conventional approach.

23-Gauge Pars Plana Vitrectomy Alone by a Bimanual Technique for the Removal of Dense Posteriorly Dislocated Crystalline Lens

Background: We sought to verify the efficacy and safety of transconjunctival 23-gauge pars plana vitrectomy (PPV) alone by our bimanual technique for the removal of dense posteriorly dislocated crystalline lens. Methods: A retrospective, noncomparative, interventional study of 31 consecutive cases of patients who underwent 23-gauge PPV alone for the removal of dense posteriorly dislocated crystalline lens following complicated cataract surgeries using our bimanual technique was conducted. The main outcomes measured included best-corrected visual acuity (BCVA), preoperative intraocular pressure (IOP), postoperative IOP and postoperative complications. Results: In all 31 cases included in this study, those dense posteriorly dislocated crystalline lenses were successfully removed. The enrolled patients consisted of 17 males and 14 females with a mean age of (75.84 ± 6.17) years (range 59 - 90). The mean follow-up length was (7.61 ± 1.87) months with a range of 6 months to 1 year. The mean preoperative BCVA was 0.22 ± 0.11 logMAR system, and the postoperative BCVA was 0.33 ± 0.07 logMAR system after 6 months of follow-up. The mean operative time was 46.32 ± 4.80 minutes with a range of 38.00 to 57.00 minutes. All of the conjunctival incisions self-closed within the first week with no wound leakage or hemorrhage. The postoperative complications were relatively rare. Conclusions: The removal of dense posteriorly dislocated crystalline lens might be a challenge for micro-incision vitrectomy. Our bimanual technique was proved to be an effective and safe method for those particular dense lenses using 23-gauge alone.

23G套管硅油取出联合部分气液交换术的临床应用

目的评估23G套管硅油取出联合部分气液交换术的临床应用效果。方法选取2020年1月至2022年6月福建医科大学附属南平第一医院行硅油取出术的71例(71眼)硅油填充患者作为研究对象。按照随机抽签法将其分为观察组和对照组。观察组35例(35眼),经结膜23G套管硅油取出并行部分气液交换术。对照组36例(36眼),经结膜23G套管硅油单纯取出。术后随访3个月,比较两组患者眼压、高眼压发生率、硅油残留率及术中、术后并发症发生情况。结果术后1周,两组患者的眼压与术前比较,差异无统计学意义(P>0.05),两组高眼压发生率比较,差异无统计学意义(P>0.05);观察组玻璃体腔硅油残留率低于对照组,差异有统计学意义(P<0.05)。术后1、3个月,两组患者眼压高于术前,差异有统计学意义(P>0.05),观察组高眼压发生率低于对照组,差异有统计学意义(P<0.05),术后1、3个月,观察组眼压低于对照组,差异有统计学意义(P<0.05)。两组患者均未发生复发性视网膜脱离、玻璃体积血以及脉络膜脱离等并发症。结论23G套管硅油取出联合部分气液交换术能有效地取净玻璃体腔硅油,减少硅油残留及高眼压的发生率,且未增加手术并发症。

经结膜无缝合23G玻璃体切除术灌注系统在玻璃体切除术后白内障手术中的应用

回顾性分析30例(30只眼)均系玻璃体切除术后白内障的患者,经结膜无缝合23G玻璃体切除术(23G TSV)灌注系统的支持下行小切口非超声乳化白内障摘除术和白内障超声乳化术,观察视力预后、术中及术后并发症。1例患者在行超声乳化时,术中发现后囊膜破裂改行小切口手术。3例患者术后低眼压,其中1例发现是脉络膜脱离所致,另外2例考虑有切口的渗漏,经处理后恢复正常。4例硬核和3例合并糖尿病视网膜病变的患者术后出现角膜水肿和前房闪辉。所有患者没有出现巩膜塌陷、晶体核沉入玻璃体腔、脉络膜上腔出血等严重的并发症。28例患者术后视力得到改善。

自制套管联合预置缝线在硅油取出术中的应用

目的评价用头皮针自制套管联合预置缝线23 G灌注、用于硅油取出术的有效性和安全性。方法回顾性分析97例改良自制套管行硅油取出术的临床效果。经结膜预置缝线后,在缝线之间做23 G微套管系统灌注,上方做穿刺口。将头皮针末端链接注射器后,剪除留有末端5~8 mm制成取油套管,套管头端扩大至刚好包住23 G套管。利用手动抽取玻璃体腔硅油,术后缝合巩膜穿刺口,并拉紧预置缝线后拔出23 G微套管。结果 97例眼均顺利完成了硅油取出术,硅油取出完全。术后的最佳矫正视力（log MAR视力）较术前有所改善,差异有统计学意义（P〈0.05）;手术后1 d、3个月的眼内压值分别较术前降低（P〈0.05）;手术时间：单纯行硅油取出术18~40（21.7±7.1）min;合并白内障摘除及人工晶体植入术35~72（45.3±15.9）min;合并二期人工晶体睫状沟植入术29~52（35.9±11.7）min。结论利用预置缝线及头皮针自制套管行硅油取出术具有安全、经济、快捷等优点。

经结膜无缝线23G套管硅油取出联合气液交换术

目的评价23G套管经结膜无缝线硅油取出联合气液交换术的治疗效果。方法回顾性分析39例曾行玻璃体切除联合硅油填充术的临床资料,硅油填充2个月以上,经结膜以23G穿刺套管抽吸硅油,部分气液交换并清除残油,部分保留玻璃体腔空气填充。观察术后情况。结果硅油抽吸时间:3.5~6.5min,平均为(4.63±0.98)min,手术全程时间为15~35min,平均为(20.1±6.2)min。术后29例(74.4%)的BCVA提高,5例(12.8%)保持不变,另有5例(12.8%)轻度下降。3例(7.7%)可见玻璃体腔少量散在乳化硅油颗粒。所有患者未出现玻璃体腔出血、复发性视网膜脱离或脉络膜脱离等严重并发症。仅有1例(2.5%)眼压低至6mmHg(1mmHg=0.133kPa),穿刺口渗液需要缝合。结论经结膜无缝线23G硅油取出联合气液交换术能有效、安全、快捷地取出玻璃体腔硅油。

玻璃体切割术后三种硅油取出方法比较

目的：比较玻璃体切割术后3 种方法取出硅油的时间与速率。方法：前瞻性临床研究。连续收集2016年10月至2017年6月于温州医科大学附属眼视光医院行玻璃体腔硅油取出术的患者52例（52眼），其中19 眼采用注射器手动取油（A组），17 眼采用玻璃体切割机取油（B组），16 眼采用改良玻璃体切割机取油（C组）。3 组均做23G两通道。A组将一小段输血管两端分别连于10 ml注射器头部与23G套管，将注射器活塞拉至底部固定后开始吸出硅油；B组将输血管一端连接23G套管，另一端连接玻璃体切割机；C组将输血管膨大部分与23G套管相连，另一端连接玻璃体切割机。B组与C组的负压由玻璃体切割机提供。记录3组的取油时间与速率（即单位时间取出的硅油量）。3组间数据比较采用方差分析法和Fisher确切概率法。结果：A、B、C组取油时间分别为（4.2±1.4）min、（6.1±1.5）min、（5.1±1.2）min，3 组间总体差异有统计学意义（F=8.9，P 〈 0.001），且A组取油时间短于B组与C组，差异均有统计学意义（P 〈 0.05）。A、B、C组取油速率分别为（1.42±0.31）ml/min（、0.94±0.21）ml/min、（1.14±0.20）ml/min，3组间总体差异有统计学意义（F=18.0，P 〈 0.001），且A组取油速率高于B组与C组，C组高于B组，差异均有统计学意义（P 〈 0.05）。A、B、C组术后第1天低眼压（≤6 mmHg）发生率分别为1/19、0/17、1/16（P=0.76），但均在术后1周恢复正常。硅油取出速率与硅油填充时间无相关性。3 组所有患者术中与术后均无其他严重并发症发生。结论：3 种硅油取出方法均安全有效，其中注射器手动取油法时间较短，速率较高。