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    Imaging, 27-gauge systems capture retina surgeons’ focus

    Instrumentation, OCT making way into surgical area for added level of control

    Retina surgeons considered 2015 to be an exciting time in the subspecialty in all areas and pointed to the availability and increased use of 27-gauge instrumentation as one of the real highlights of surgical retina. Imaging is also capturing surgeons’ attention.

    Cutting speeds and 27-gauge systems

    “We have lived a very exciting decade in retina on the medical and surgical fronts and that remains the case up to the current time,” Carl Regillo, MD, said.

    On the surgical front, both he and Mary Elizabeth Hartnett, MD, noted that increased cutting speeds with conventional 23- and 25-gauge instruments are important in that they result in increased safety during vitrectomy.

    “Higher cut rates translate into less traction on the retina,” said Dr. Regillo, director of the Retina Service, Wills Eye Hospital, and professor of ophthalmology, Thomas Jefferson University, Philadelphia.

    However, the 27-gauge systems are especially noteworthy because of the added level of control afforded to surgeons.

    “The introduction of 27-gauge systems plays a role in how we approach certain vitreoretinal disorders that are treated surgically,” he said. “These systems are especially beneficial in the setting of tractional retinal detachments in patients with diabetic retinopathy.”

    Another advantage enjoyed by surgeons in addition to better control is the improved ability to dissect membranes using the smaller 27-gauge probe.

    However, these smaller instruments are not used across the board. They are thinner and, therefore, not as strong as the larger-gauge instruments.

    “There is some instrument flexibility and we are likely to see the 27-gauge instruments being used selectively and not for all cases,” Dr. Regillo explained.

    Dr. Hartnett, professor of ophthalmology, John A. Moran Eye Center, Salt Lake City, specializes in treating both pediatric and adult retinal cases, also sees 27-gauge instrumentation as promising—especially for tractional diabetic retinal detachments and uveitis-associated retinal detachments

    “These instruments allow surgeons to get closer to the retina to remove membranes without exerting traction and injuring the retina or causing hemorrhage,” she said. “Rather than using a two-handed technique, surgeons can remove membranes from the retinal surface safely.”

    However, despite the fact that the 27-gauge instrument systems seem as though they should be beneficial in pediatric retinal cases, Dr. Hartnett prefers the larger-gauge instruments because the vitreous is more formed in babies.

    “Perhaps it is because the severity of the pathology is greater, but I find myself performing more two-handed techniques,” she said. “I often use even 23-gauge instruments to cut and aspirate vitreous gel.

    “Twenty-seven gauge instruments are best in cases when surgeons want to perform very gentle dissections, such as in patients with diabetic retinal detachments with thin retinas and thick membranes,” she added. “The small gauge instruments facilitate removal of the membranes without damaging the underlying retinal tissue.”

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