ABSTRACT
O objetivo deste estudo foi avaliar o crescimento microbiano em sondas para vitrectomia de uso único, reprocessadas na prática assistencial. Foram investigadas nove sondas reusadas e reprocessadas por diferentes métodos. As sondas foram segmentadas, individualmente, em porções de 3,5 cm, totalizando em 979 unidades amostrais (extensões, conectores e ponteiras) inoculadas em meio de cultura e incubadas a 37ºC, por 14 dias. Os resultados mostraram crescimento microbiano em 57 (5,8%) unidades amostrais, das quais, 25 foram esterilizadas por Óxido de Etileno, 16 por Plasma de Peróxido de Hidrogênio e 16 por Vapor à Baixa Temperatura e Formaldeído. Foram identificadas 17 espécies microbianas, sendo as mais prevalentes o Micrococcus spp., Staphylococcus coagulase negativa, Pseudomonas spp. e Bacillus subtilis. O reuso de sondas de uso único para vitrectomia não se mostrou seguro, portanto tal prática não é recomendada.
The aim of this study was to evaluate the microbial growth on single-use vitrectomy probes reprocessed in healthcare practice. We investigated nine vitrectomy probes that had been reused and reprocessed using different methods. The samples were sectioned, individually, in portions of 3.5 cm, totaling 979 sampling units (extensions, connectors and vitrectomy cutters), which were inoculated in culture medium and incubated at 37ºC for 14 days. The results showed microbial growth on 57 (5.8%) sample units, 25 of which had been sterilized using ethylene oxide, 16 by hydrogen peroxide plasma, and 16 by low-temperature steam and formaldehyde. Seventeen microbial species were identified. The most prevalent were: Micrococcus spp., coagulase-negative Staphylococcus, Pseudomonas spp., and Bacillus subtilis. The reuse of single-use vitrectomy probes was shown to be unsafe, therefore this practice is not recommended.
Este estudio objetivó evaluar el crecimiento microbiano en sondas para vitrectomía de uso único recicladas en la práctica asistencial. Se investigaron nueve sondas reutilizadas y recicladas mediante diferentes métodos. Las sondas fueron segmentadas individualmente en porciones de 3,5 cm, totalizándose 979 unidades de muestra (extensiones, conectores y punteras), inoculadas en medio de cultivo e incubadas a 37ºC por 14 días. Los resultados demostraron crecimiento microbiano en 57 (5,8%) unidades de muestra, 25 de las cuales habían sido esterilizadas con óxido de etileno, 16 con plasma de peróxido de hidrógeno y 16 por vapor a baja temperatura y formaldehido. Se identificaron 17 especies microbianas, prevaleciendo el Micrococcus spp, Staphylococcus couagulasa negativo, Pseudomonas spp y Bacillus subtilis. La reutilización de sondas de uso único para vitrectomía no demostró seguridad, por lo que la práctica no es recomendable.
Subject(s)
Bacteria/growth & development , Bacteria/isolation & purification , Equipment Contamination , Sterilization , Vitrectomy/instrumentation , Equipment ReuseABSTRACT
A pilot study was designed to evaluate the safety and efficacy of 23-gauge vitrectomy under topical anesthesia. Five eyes of five patients underwent 23-gauge sutureless vitrectomy under topical anesthesia with a pledget soaked in 0.5% proparacaine hydrochloride anesthetic, for vitreous hemorrhage (four eyes), epiretinal membrane (one eye). Subjective pain and discomfort were graded using a visual analogue chart from 0 (no pain or discomfort) to 4 (severe pain and discomfort). At the end of surgery no patch was applied and patients were given dark glasses. Patients underwent an immediate postoperative assessment, followed by next day and one week postoperative evaluation. Four patients had Grade 0 pain during the surgery. One patient had Grade 1 pain during the placement and withdrawal of the micro cannulas. The surgical outcomes were favorable. 23-gauge vitrectomy under topical anesthesia is safe and effective in selected cases. Further study is recommended to validate the outcome of this study.
Subject(s)
Adult , Anesthesia, Local , Anesthetics, Local , Catheters , Equipment Design , Follow-Up Studies , Humans , Middle Aged , Pilot Projects , Propoxycaine , Treatment Outcome , Vitrectomy/adverse effects , Vitrectomy/instrumentation , Vitrectomy/methodsABSTRACT
We experienced two cases of the influx of the sclerotomy site bleeding into the anterior chamber during 23-gauge sutureless vitrectomy for pseudophakic rhegmatogenous retinal detachment. Soon after the removal of a 23-gauge microcannula at the end of the surgery, presumed sclerotomy site hemorrhage was rapidly fluxed into the anterior chamber. The anterior chamber bleeding might come from the sclerotomies rather than from episcleral vessels. The posterior pressure in the gas-filled pseudophakic eye might have pushed the sclerotomy site bleeding into the anterior chamber. We could not find any vitreous hemorrhages. The hemorrhage within the anterior chamber spontaneously absorbed within 14 days.
Subject(s)
Anterior Chamber , Catheters , Eye Hemorrhage/etiology , Humans , Male , Middle Aged , Retinal Detachment/surgery , Sclerostomy/adverse effects , Sclerostomy/instrumentation , Vitrectomy/adverse effects , Vitrectomy/instrumentation , Vitrectomy/methodsABSTRACT
The advent of smaller gauge instrumentation allows for minimally invasive vitreoretinal surgery (MIVS) as compared to conventional pars plana vitrectomy. Sutureless posterior segment surgery has the advantages of faster wound healing, minimal surgical trauma, decreased convalescence period besides reduced postoperative astigmatism; however, slower gel removal and limited peripheral vitreous dissection are disadvantages with smaller gauge systems. We herein describe a new technique combining 23-gauge and 20-gauge vitrectomy to improve the effectiveness and outcomes of vitreoretinal surgery.
Subject(s)
Conjunctiva , Equipment Design , Humans , Retinal Diseases/surgery , Retrospective Studies , Minimally Invasive Surgical Procedures/instrumentation , Treatment Outcome , Vitrectomy/instrumentationABSTRACT
Incarceration of vitreous in sclerotomy sites during pars plana vitrectomy can lead to wound-related complications similar to vitreous incarceration in cataract surgery. We describe an illuminated curved 25-gauge vitrectomy probe for removing vitreous from sclerotomy sites. Polyester tubing is used to secure a fiber optic endoilluminator (0.5 mm) with the curved 25-gauge vitrector (0.5 mm). The resultant illuminated curved vitrector (20 G) has a diameter of 1.0 mm. It facilitates complete removal of vitreous around the internal sclerotomies under direct visualization in both phakic and pseudophakic eyes. The same was confirmed with ultrasound biomicroscopy of the sclerotomy sites. Curved vitrector reduces postoperative complications related to incarcerated vitreous in phakic and pseudophakic eyes and other sclerotomy-related wound complications.
Subject(s)
Humans , Lighting/instrumentation , Microsurgery/instrumentation , Sclerostomy , Vitrectomy/instrumentation , Vitreous Body/surgeryABSTRACT
AIMS: To evaluate the safety and efficacy of transconjunctival 25 gauge vitrectomy under topical anesthesia. SETTINGS AND DESIGN: A pilot study of consecutive cases which underwent 25 gauge vitrectomy under topical anesthesia. MATERIALS AND METHODS: Seven eyes of 7 patients underwent 25 gauge vitrectomy under topical anesthesia with a pledget soaked in anesthetic, for vitreous hemorrhage (2 eyes), retained cortex (1 eye) and postoperative endophthalmitis (4 eyes). Subjective pain and discomfort were graded from 0 (no pain or discomfort) to 4 (severe pain and discomfort). Patients underwent an immediate postoperative assessment, followed by day one and one week postoperative evaluation. RESULTS: All patients had grade 0 pain during the surgery. Five patients had grade 2 pain during the placement of the sclerotomies. None of the patients required any sedation during the procedure. No inadvertent eye movements were noted during surgery. Except one patient, none required postoperative analgesics. Five eyes had a favorable outcome. No eyes in this pilot study had any procedure-related complications. CONCLUSION: With appropriate case selection, topical anesthesia is a safe and effective alternative to infiltrative anesthesia for 25 gauge vitrectomy. A larger series of patients with a longer follow-up is required to validate the findings of this pilot study.
Subject(s)
Administration, Topical , Adult , Aged , Anesthesia, Local/methods , Anesthetics, Local/administration & dosage , Endophthalmitis/surgery , Equipment Design , Female , Follow-Up Studies , Humans , Male , Middle Aged , Pilot Projects , Treatment Outcome , Vitrectomy/instrumentation , Vitreous Hemorrhage/surgeryABSTRACT
We describe the principle and desiign of a new self-retaining contact lens system for vitreous surgery. The system has three lenses: theplano-concave, prism and magnifying lens. This system is based on the principle of a direct imaging contact lens, designed for a 150-200mm focal length operating micrcroscope. The contact lenses are designed to have an inferior concave surface [radius of curvature (ROC) 7.7mm], modified by theaddition of four footplates to provide stability and centration during vitreous surgery. The lenses are used with a drop of viscoelastic material placed between the concave surface of the contact lens and cornea. This induces negative suction and helps retain the lens in position during surgery. These specially designed lenses provide a stable, well-centered, high-resolution, magnified view of the fundus. This system eliminates the need for a skilled assistant or for suturing the lens to the sclera during vitreous surgery.
Subject(s)
Contact Lenses , Equipment Design , Humans , Vision, Ocular/physiology , Vitrectomy/instrumentation , Vitreous Body/surgeryABSTRACT
This report presents the effectiveness of 25-gauge Transconjunctival Sutureless Vitrectomy (TSV) for various vitreoretinal disorders. We performed vitreoretinal surgery on 6 patients using 25-gauge TSV. Minimal or no leakage of intraocular fluid or gas was observed at the entry site. No case required a suture to close the conjunctival or scleral opening site, and no complications resulted from the opening site. Median preoperative visual acuity was 0.04 and median postoperative best corrected visual acuity (BCVA) with a mean follow-up of 12 weeks, was 0.45. Median preoperative intraocular pressure was 12.67mmHg, and median intraocular pressure on the first postoperative day was 15.67 mmHg. Because transconjunctival sutureless surgery is minimally invasive, it increases the efficiency of vitrectomy, hastens postoperative recovery, and improves outcomes due to the simplified surgical procedure. We feel that the adoption of the 25-gauge TSV would lead to improved patient comfort, care, and management.
Subject(s)
Adult , Aged , Child, Preschool , Female , Humans , Male , Middle Aged , Follow-Up Studies , Retina/surgery , Retinal Diseases/surgery , Retrospective Studies , Visual Acuity , Vitrectomy/instrumentation , Vitreous Body/surgeryABSTRACT
In the presence of proliferations anteriorly, adequate excision of the vitreous base is essential. To enable a good vitreous base excision, removal of lens often becomes necessary as it may be damaged while attempting to remove peripheral vitreous. To avoid damage or the need to remove the crystalline lens we have used a new modified curved vitreous cutter along with a wide angle observation system binocular indirect ophthalmomicroscope (BIOM). Use of BIOM during vitreous surgery enables easy viewing of the retinal periphery without the need for scleral depression. Sclerotomies are made as for any regular three-port vitrectomy procedure and the vitrectomy is carried out using the curved vitreous cutter, including the vitreous base, avoiding damage to the crystalline lens. The modified curved vitreous cutter is helpful in removing the peripheral vitreous without damaging the crystalline lens, giving the patient the advantage of intraocular lens implantation at a later date.
Subject(s)
Equipment Design , Follow-Up Studies , Humans , Recurrence/prevention & control , Retinal Detachment/complications , Vitrectomy/instrumentation , Vitreoretinopathy, Proliferative/complications , Vitreous Body/surgeryABSTRACT
Comparou-se o uso de três equipamentos ópticos disponíveis comercialmente para a realizaçäo de vitrectomias com o uso de lentes de grande angular, durante a realizaçäo de vitrectomias via pars plana. Os equipamentos utilizados foram: Advanced Visual Instruments (A VI), que requer o uso de lente de contato (C) corneana; o binocular Indirect Ophthalmomicroscope System (BIOM), composto de dois sistemas, um sistema de contato (BIOMC) e um sistema de näo contato (BIOM-NC); e o Erect Indirect Ophthalmscop System (EIBOS), que é um sistema de näo contato. Foram identificados catorze parâmetros para a avaliaçäo de cada um destes sistemas em vitrectomias realizadas em 16 olhos de 8 coelhos adultos pigmentados, da mesma raça e cor. Cada parâmetro foi classificado ..
Subject(s)
Animals , Rabbits , Vitrectomy/instrumentationABSTRACT
O autor descreve uma técnica simplificada para implantaçäo de lente intra-ocular de câmara posterior com fixaçäo escleral em olhos sem suporte capsular. A cirurgia foi realizada em 11 olhos afácicos e em 4 outros com rupturas extensas da cápsula posterior durante a execuçäo da extraçäo extracapsular da catarata. Em 10 dos 11 olhos afácicos (91%), a acuidade visual corrigida permanecu inalterada. Em todos os olhos com implantaçäo primária, a acuidade visual foi igual ou melhor que 20/25. A exceçäo de um olho que desenvolveu edema macular cistóide, näo se observaram outras complicaçöes importantes
Subject(s)
Humans , Adult , Middle Aged , Cataract Extraction/rehabilitation , Lenses, Intraocular , Suture Techniques/methods , Brazil , Visual Acuity/classification , Vitrectomy/instrumentationABSTRACT
Injeçäo intravítrea de óleo de silicone é mais facilmente realizada com uma seringa graduada, originalmente utilizada na prática veterinária