resge in ight - Kresge Eye Institute

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resge in ight - Kresge Eye Institute

H‘appy medium’ is latest innovation in vitrectomyWhen 25-gauge pars plana vitrectomy was introducedsix years ago, it brought many improvements in patientoutcomes after retinal surgery. The smaller scleralincisions meant the three surgicalports would seal without sutures,reducing patient discomfort,speeding recovery and decreasingsurgical times. Also, since suturesare not used, there is minimalinduced postoperative astigmatism.But the move from 20-gauge to 25-gaugeinstruments had some drawbacks, notes AsheeshTewari, M.D., a retinal surgeon at DMC KresgeEye Institute and an assistant professor in theophthalmology department at Wayne StateUniversity School of Medicine.“With the more-delicate instruments, flexibilitybecame a problem,” Dr. Tewari notes. “It wasmore difficult to perform complicated surgicalmaneuvers, such as removing peripheral vitreousand repairing complex retinal detachments.”As a response, 23-gauge instrumentation wasdeveloped several years ago as a “happy medium.”Dr. Tewari was one of the first in the United Statesto use 23-gauge instruments when they becameavailable.Dr. Tewari joined KEI in 2007 and performs about 95 percent of hisvitrectomies using the new technology, or more than 20 cases per month.“Outcomes are just as good as with 20-gauge instrumentation and you’re gettingthe same effect in time savings and patientcomfort as 25-gauge,” he comments. “Thesurgery is still sutureless and the more-rigidinstrumentation allows greater rotation ofthe eye and the ability to perform a morecompletevitrectomy. In addition, with newerwide-angle light probes, there is improvedvisibility of the peripheral retina and thelarger vitrectors allow for optimum removalof vitreous gel.” At the same time, patientshave a quicker postoperative recovery and aremore comfortable after retinal surgery.Dr. Tewari is currently working with devicemanufacturers to develop and test a newgeneration of vitrector with a significantlyfaster cut rate.“We’ve learned that if we pull too muchwhen aspirating with the vitrector, it createsretinal tears. With the higher-speed cuttersthe action is more like shaving off smallerbits of tissue, which improves outcomes.”www.dmc.org

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