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    Enhancing retinal surgery with 27-gauge instrumentation

    Advantages include less hypotony, reduced bleeding with fewer iatrogenic breaks

    Compared with larger instrumentation, 27-gauge instrumentation has several advantages, particularly in complex cases, said Maria H. Berrocal, MD.

    Some common problems during retinal detachment surgery include iatrogenic breaks, perioperative hemorrhage, hypotony, and the need for re-operations, said Dr. Berrocal, director of Berrocal and Associates, San Juan, Puerto Rico.

    Dr. Berrocal cited findings that iatrogenic breaks occur 13% to 35% of the time with 20- and 25-gauge instrumentation in complex pathologies.

    Advantages of 27-gauge include new surgical techniques, blunt dissection, access to tight tissue planes, the ability to shave membranes, peel tissue, reduce traction on the retina, and aspirate with a vitrector. Photos courtesy of Maria H. Berrocal, MDIn contrast, “we’ve seen published cases of reduced intraoperative and sclerotomy-associated breaks with smaller gauges,” Dr. Berrocal said.

    In one published series, no iatrogenic breaks or sclerotomy-associated tears were seen with 27-gauge usage.

    Hypotony can occur in zero to 32% of patients at day 1 with use of 23-gauge instrumentation, Dr. Berrocal said. Up to 70% of eyes can have subclinical choroidal detachment.1

    With postoperative hemorrhage, a main problem of vitrectomy, the incidence is 5% to 80%, with one-third of eyes requiring an intervention or re-operation.

    However, a new study found an incidence of only zero to 5% with 27-gauge usage, she said.2

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