Innova Ocular - ICO Barcelona

Micro-incision Vitrectomy 23-gauge

23-gauge vitrectomy is a minimally invasive surgical technique that allows many diseases of the posterior segment of the eye to be treated successfully.

What does it entail?

Vitrectomy is a surgical technique that involves removing the vitreous humour from the eye. Vitreous humour is a gel-like substance that is composed mainly of water, although it also contains collagen fibres that give it a gelatinous consistency. The word micro-incision means that we enter the eye through very small openings, which are much smaller than they were a few years ago.

Why is vitrectomy used?

We use this technique to treat diseases of the vitreous humour and to access other retinal diseases, including but not limited to retinal detachment, diabetic retinopathy, macular diseases, uveitis or eye trauma.

How is it done exactly?

It involves inserting very small gauge instruments through the wall of the eye to access the vitreous cavity. We normally make three incisions: one to insert an infusion cannula to keep intraocular pressure constant, another for the intraocular fibre optic light, and the last to insert the vitrectome, the instrument used to cut and suction the vitreous gel out of the eye. 

The vitreous humour must not be removed by suction alone. It must be cut away to avoid traction on the retina that could cause severe complications. 

The cutting rate is very fast, with up to 5000 cuts per minute. This way we prevent vitreous traction on the retina. All parameters (pressure, suction, cutting, etc.) are controlled by an instrument (vitrectome) that is operated by the surgeon. There are also other instruments that we use at different times during the surgery: forceps, intraocular laser probes, scissors, electrodes, etc.

Let's take a look at the size of the vitrectomy incisions

All of these instruments are inserted into the eye through small-gauge cannulas, which allow for better movement inside the eye and reduced complications. The incisions we make are smaller than 1 mm. We normally talk about gauges (g) when referring to the size of cannulas and instruments used during surgery. The gauge most commonly used today is 23 g, which is used for practically all vitrectomy surgeries. There are surgical instruments with even smaller gauges, 25 and 27 g, but these are much more flexible and that reduces the accuracy of movements in many surgeons' opinions.

What advantages does the latest micro-incision technology offer?

The smaller size of incisions made in the eye has resulted in huge advances by reducing eye trauma during surgery and post-operative inflammation. It means we no longer have to open up the conjunctiva, there are fewer corneal lesions, less inflammatory reaction in the anterior chamber after surgery and sutures are often not required to close the incisions made.

Once the vitreous humour has been removed and the damaged intraocular structures have been repaired, we can then decide whether to use saline solution, gas or silicone oil to replace the vitreous humour inside the eyeball, based on the disorder suffered by the patient and the surgeon's decision. 

Is it available at ICO?

ICO has been performing vitrectomies since its establishment in 1989, initially in patients with severe eye trauma. ICO's vitreoretinal surgeons use the most advanced 23G Micro-incision Vitrectomy system at the CEM Clinic.

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