25 gauge vitrectomy: A schema for the learning curve

William van Aldred (Pensacola)

25 gauge vitreous surgery is gaining popularity. The possibiliy for more rapid wound healing and reduced inflammation, resulting in shorter postoperative recovery times is attractive to patients and surgeons alike. Reasons for considering adoption of this important surgical modification will be reviewed. As with any new procedure, a “ learning curve” is to be expected. This paper presents a systematic approach to this learning curve. A “step-ladder” schema is presented which will hopefully aid surgeons of differing experience levels as they approach this important operative transition. In this program, the surgeon moves from relatively straightforward to progressively more challenging cases. Hopefully, this approach will reduce complications and incrementally build skill and familiarity with the 25 g “sutureless” technique. This schema has been developed in a busy two-surgeon practice, and reflects a six month transitional period. The rationale for this stepladder approach, as well as common pitfalls, will be discussed.

25 gauge vitrectomy: Handling Complications

Any new surgical technique or modification presents its own set of pitfalls and complications. This paper will focus on complications experienced in the learning curve schema described previously. Problems unique to 25G vitrectomy will be reviewed. Considerations of preoperative planning, anesthetic technique, entrance and exit strategy,and adverse intraoperative events are reviewed. Common complications, such as engineering, insertional, visualization, end-operative, and postoperative difficulties are discussed. Particular emphasis is given to concerns regarding hypotony, emorrhage, and infection prevention.


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