JOURNAL REVIEW

ADVANCES IN
VITREORETINAL
SURGERY
DR.BHARTI AHUJA
 VITRECTOMY
 Microsurgical procedure to remove some or all of
the vitreous humour from the eye.

TYPES
 OPEN SKY VITRECTOMY(KASNER,1960S)-excision of
damaged or diseased vitreous through a large limbal
incision or a corneal wound.

 CLOSED SYSTEM(MACHEMER,1970s)-Trans pars plana

vitrectomy.-two port vitrectomy
three port vitrectomy(current technique in use)
four port vitrectomy
OCULAR ANATOMY FOR PARS PLANA
INDICATIONS

OF VITRECTOMY
Vitreous haemorrhage(diabetic and other causes)
 Vitreous inflammation-noninfectious
infectious(endophthalmitis)
 Vitreous floaters (significant&nonsignificant)
 Retinal detachment repair
 Macular holes repair
 Retinal scar tissue- removal(idiopathic,diabeticrelated,associated
with RD)
 Retained cataract fragments aftercataract surgery-removal
 Dislocated lens implants –retrieval
 Retinopathy of prematurity-repair
 Refractory diabetic macular edema-membrane peeling and
vitrectomy
 Severe ocular trauma-repair and removal of intraocular foreign
bodies
 Indeterminate diagnosis (obtain intravitreal specimen)
PRINCIPLE OF VITRECTOMY(CLOSED )
 The operation is performed through water
tight incisions,so that the IOP is maintained
in a suitable normal range throughout the
procedure and needed amount of
instruments is not restricted.
 Minimum levels of suction force are used
throughout the operation to avoid creating
retinal breaks.
PROCEDURE OF
VITRECTOMY(CLOSED)
 Anaesthesia –local -peribulbar(occasionally
general)
 Site of incision –pars plana i.e. 3-4 mm
posterior to the anterior margin of
limbus(optimal location)
 Size of incision-3.5 mm,(1 mm with 20 guage
instruments)
 Three incisions-sclerotomies/ports

inferotemporal,superotemporal and
superonasal
( infusion,vitreous probe and endoilluminator)
THREE PORT CLOSED SYSTEM PARS
PLANA VITRECTOMY
VITREOUS PROBES(2 TYPES)
 Full function(tip dia-2.2-2.5 mm )-VISC-not in use(combined
infusion ,cutting and suction)-larger incision.A fiberoptic illumination-
sleeve around the tip.
 Divided function probes(tip dia-0.9-1.5 mm)-currently in use(smaller
incision)
 Modern vitreous probes-suction and cutting.

pneumatic/electronic cutters
QUALITIES
 Higher cut rates (100-2500 cuts/min)

 Lower flow rate

ENDOSCOPES FOR VITREORETINAL
SURGERY

CORNEAL CONTACT LENSES

 Plano concave

 Self retaining

 Lenses attached with infusion system

 Prismatic /angulated (mainster)

ILLUMINATION
 19/20guage light pipe ,halogen monofilament
source
ADVANTAGES OF THREE PORT
VITRECTOMY(20 GUAGE)
 Reduced size of the instrument
 Reduced weight of the instrument

 Smaller incision

 Better visualization
DISADVANTAGES

 Sutured wound
 Ocular surface inflammation
 Postoperative discomfort
 Postoperative retinal tears(5-10%cases)
COMPLICATIONS OF VITRECTOMY
 Cataract progression
 Infection (endophthalmitis)
 Retinal tear
 Retinal detachment
 Hypotony
 Glaucoma
 Vitreous cavity hemorrhage
 Suprachoroidalhemorrhage
MIVS(MICROINCISIONAL VITRECTOMY
SURGERY)-
EVOLUTION OF MIVS
 Dr,STANLEY CHANG(1993)-23 guage system.
 EUGENE DE JAUN(2001)-transconjunctival 25
guage sutureless vitrectomy system
 CLAUS ECKHARDT ETAL(2005)-23 guage
sutureless vitrectomy system.
CURRENT THREEPORT TECNIQUE IN
MODERN VITERORETINAL SURGERY
 Divided system of instrumentation(1st
complete divided system-ocutome ,a set of 20
guage instruments-CARL WANG,mid 1970s)
 Three separate sclerotomies(ports)< 1 mm
incision,i.e.23 &25 guage instruments.
 Xenon light source(Cold light,near normal
colour to tissues)

ENDOSCOPES
 19gaugewith 110° field

 20gauge with 50° field

OPHTHALMIC ENDOSCOPIC SYSTEM
UNIT
PHOTOGRAPH OF AN EYE DREPPED AND
UNDERGOING A 3-PORT
VITRECTOMY PROCEDURE
XENON LIGHT COMPARED WITH HALOGEN LIGHT
WIDE ANGLE FUNDUS OBSERVATION
SYSTEM

 The BIOM noncontact system with a field of

view of 70°, 90° or 110°
 The EIBOS noncontact system with a field of
view of 100° for 90 – diopter and 125° for 60
– diopter.
 The VOLK reinverting operating lens system
(ROLS); can be used to visualise upto
vitreous base and ora serrata.
 The AVI inverter.

 The iris medical contact wide-angle system

BIOM3
ADDITIONAL SURGICAL STEPS AS A PART
OF MODERN VITREORETINAL SURGERY
 Membranectomy
 Fluid air exchange
 Air-gas exchange
 Silicon oil injection
 Photocoagulation
 Scleral buckling
 Lensectomy
THE JOURNAL OF RETINA AND VITREOUS,FEB
2009,VOL29,ISSUE2,PG225-231

NAGPAL, MANISH MS, DO, FRCS; WARTIKAR, SHARANG MS;

NAGPAL, KAMAL MS

Comparison of Clinical Outcomes and Wound Dynamics of

Sclerotomy Ports of 20, 25, and 23 Gauge Vitrectomy

Purpose: To compare the benefits, the risks and the dynamics of port
closure in different gauge vitrectomy systems.

Results: Vision improved from 0.048 (3/60) to 0.206 (6/24) (p = 0.0021),

from 0.069 (4/60) to 0.389 (6/18) (p < 0.0001) and from 0.055 (3/60) to
0.286 (6/24) (p = 0.0010) with 20, 23, and 25-G systems, respectively.
Re-bleeds occurred in 4, 1 and 4 eyes of 20, 23 and 25-G systems
respectively and post-operative retinal detachment was seen in 2
cases of 20-G system. There were no cases of post-operative hypotony
or endophthalmitis seen. With 23 and 25 gauge systems, significant
amount of vitreous was seen blocking the inner lip of the sclerotomy
ports.
CONCLUSION

The small guage systems are

equally and
efective as 20 guage systems for
noncomplicated cases of vitreous
haemorrhage with faster recovery
and more
comfort of the patient.
Indian journal of ophthalmology,2007(vol.55 ,issue3,page
203-206)

Vandana jain,dharmesh kar,s.natrajan,debraj shome,hitendra

mehta,hijab mehta,Chaitra jaydev,nishikant borse
.
PHACOEMULSIFICATION AND PARS PLANA
VITRECTOMY:A COMBINED
PROCEDURE

To describe the results of a combined procedure including

phacoemulsification,Insertion of PCIOL,and pars plana
vitrectomyin
eyes with vitreoretinal pathology and coexisting cataract.
Results: In all, 65 eyes of 64 patients were included. The mean age
of the patients was 50.9 years ± 17.1 (range, five to 82 years).
Vitreous
hemorrhage with or without retinal detachment (19 eyes, 29.2%) was
the most common indication for the vitreoretinal procedure. Primary
anatomical success of retina was achieved in 59 eyes (90.7%). Visual
acuity improved in 48 eyes (73.8%), was unchanged in 12 eyes
(18.5%) and deteriorated in five eyes (7.7%). Postoperative
inflammation was significantly more in the subgroup of previously
vitrectomized eyes (42%)
( P =0.014, Fisher exact test) compared to those which underwent
primary vitrectomy..

CONCLUSION

Combined surgery is a feasible option for

patients with cataract and vitreoretinal
diseases.
COMPLICATIONS WITH MIVS

 HIGHER INCIDENCE OF RETINAL

TEARS/DETACHMENTS
 ENDOPHTHALMITIS

 WOUND LEAKAGE &HYPOTONY

 CHOROIDAL HAEMORRHAGE
&DETACHMENTS
 CONJUNCTIVAL BLEBS FORMATION
OPH SOURCE
OPHTHALMOLOGY,VOL.116,ISSUE 7,PAGE
1360-65,JULY 2009,

ENDOOPHTHALMITIS AFTER PARS PLANA

VITRECTOMY: 25 G AND 20G COMPARISON

Comparison of incidence rate of endophthalmitis

after 25 guage
sutureless versus 20 guage sutured vitrectomy on a
large cohort of
patients operated with a standardized perioperative
anti-infection
protocol.
Of 3372 PPV surgeries meeting inclusion and exclusion criteria, 1948
and 1424 surgeries were 20- and 25-gauge PPVs, respectively. Average
age (± standard deviation) of patients was 54.6 (± 22.6) and 64.4 (± 16.5)
years in the 20- and 25-gauge PPV groups, respectively (P<0.0001).
Median post-PPV follow-up time was not significantly different between
the 2 groups (12.5 vs 13.0 months; P = 0.69). Endophthalmitis was
observed in 1 patient (0.07%; 95% confidence interval, 0%–0.21%) from
the 25-gauge group and none in the 20-gauge group (P = 0.42; Fisher
exact test, 2-tailed). The use of air/gas endotamponade (P<0.0001) and
intravitreal triamcinolone (P<0.001) was more common in 25- versus 20-
gauge PPV
.
CONCLUSION

The incidence of endophthalmitis was low in both groups,but

the study was unable to show any significant difference
between the incidence after 25 guage and 20 guage and thus
concluded that preioperative antiinfection control may reduce
the risk associated with 25 g PPV to that of 20 g PPV.
PULSED ELECTRON AVALANCHE
KNIFE IN VITREORETINAL
SURGERY:
:
precise,cold and tractionless dissection of
tissue in liquid media.


greatly facilitate both

posterior surgeries like membrane dissection
and sheathotomy as well as anterior
segment procedures trabeculectomy and
iridectomy.
ADVANTAGES OF PEAK

 Sharpely defined transection &incision of

epiretinal membranes.
 Fine coagulation of vascularized epiretinal
tissue during surgery for traction RD.
 Traction free dissection of attached and
elevated retina.

 Mid infra red laser based cutting in

vitreoretinal surgery-to minimize the
collateral damage with high
cutting,minimize the liquification rates.
CONTRAINDICATIONS OF
VITRECTOMY
 Failure to obtain appropriate informed
consent
 Bleeding diathesis/anticoagulation

 Corneal/other opacity precluding adequate

visualization
 Scleromalacia or otherconditions that may
prevent adequate wound healing
 Suspected neoplasm as
retinoblastoma[seedingorbit]
 Other medical contraindication to
anaesthesia/surgical procedure.
British journal of ophthalmology 2009,93 787-90

25 GUAGE FOR PAEDIATRIC

VITREORETINAL
CONDITIONS.
C R GONZALES,S SINGH, S D SCHWARTZ

To evaluate the feasibility and safety of 25-gauge vitrectomy for various

vitreoretinal indications in the paediatric population.
intervention, choroidal detachment, endophthalmitis or sclerotomy
related retinal breaks.
Results: 56 eyes in 49 children (16 girls and 33 boys) were
included. Intraoperative unplanned events or complications
included: conversion to 20-gauge vitrectomy (four), conversion of
one port to a 20-gauge sclerotomy (two), suspected lens damage
(one) and intraoperative bleeding from a vascular ridge (one).
Postoperative complications included cataract (five),
rhegmatogenous retinal detachment (four) and vitreous
haemorrhage (three). The four retinal detachments were either
recurrent or occurred in eyes with complex ocular pathology and
were not felt to be related to the surgical technique. There were no
cases of postoperative hypotony requiring intervention, choroidal
detachment, endophthalmitis or sclerotomy-related retinal breaks.

25 guage vitreoretinal techniques can

be used in various paediatric
Vitreoretinal diseases.It actually
facilitates access to small spaces of
Paediatric eye.
RETINAL DETACHMENT REPAIR
 SCLERAL BUCKLING - a surgical procedure in which a
piece of silicone plastic or sponge is sewn onto the sclera
at the site of a retinal tear to push the sclera toward the
retinal tear. The buckle holds the retina against the
sclera until scarring seals the tear.
 PNEUMATIC RETINOPEXY

 VITRECTOMY- Recommended in situations like

large &posterior retinal tears

vitreous haemorrhage
giant retinal tears
advanced retinal scarring(PVR)
SCLERAL BUCKLING
 Anaesthesia-local(peribulbar) preferred
 Circumcorneal conjunctival incision(peritomy)-at
the limbus /4mm posterior to it.
 Each of the 4 recti muscles-isolate with a muscle
hook,2-0 silk under the insertion
 Localization of the retinal breaks

 Chorioretinal adhesion-retinopexy-
cryotherapy,diathermy,photocoagulation(laser)
 Securing the scleral buckle

 Drainage of subretinal fluid

 closure
CRYOPEXY/CRYOTHERAPY
POSTOPERATIVE COMPLICATIONS OF
SCLERAL BUCKLING SURGERY
 Choroidal detachment
 Elevated IOP

 Cystoid macular edema

 Endophthalmitis

 Infection/extrusion of buckling element

 Diplopia

 Proliferative vitreoretinopathy

 Persistent/recurrent retinal detachment

 AMERICAN JOURNAL OF OPHTHALMOLOGY,JUNE 2008

Primary Vitrectomy without Scleral Buckling for Pseudophakic

Rhegmatogenous Retinal Detachment
To report the anatomic and functional results of primary vitrectomy without
scleral buckling for the treatment of pseudophakic rhegmatogenous retinal
detachment (PsRD)

Results Mean follow-up ± standard deviation (SD) was 12 ± 6.3 months

(range, seven to 36 months). Mean final visual acuity ± SD was 0.42 ± 0.45
logarithm of the minimum angle of resolution (logMAR) compared with 0.95 ±
0.73 logMAR before surgery (P < .01). Mean number ± SD of retinal breaks
found before surgery was 1.36 ± 1.12 (range, zero to five), and an additional
1.58 ± 2.26 (range, zero to 15) retinal breaks were found during surgery. The
retina was reattached successfully after a single surgery in 92 eyes (92%).
Recurrence of retinal detachment occurred in eight eyes (8%), caused by
proliferative vitreoretinopathy in six eyes (75%) and by new breaks in two
eyes (25%). Final anatomic reattachment was obtained in these cases after a
mean of 1.75 subsequent operations.
Three eyes required permanent silicone oil tamponade so that final
anatomic success was achieved in 97 eyes (97%). The most
common postoperative complication was ocular hypertonia of more
than 21 mm Hg, observed in 36 (36%) eyes, which was managed
successfully.

CONCLUSION
Primary vitrectomy was successful in terms of anatomic success
without scleral buckling in patients with Ps RD associated with few
complications.
JOURNAL OF RETINA ,AUG 2008 VOL 28 ISSUE 7 PG 931-936

Primary Repair of Retinal Detachment With 25-Gauge Pars Plana

Vitrectomy

Miller, Daniel ; Riemann, Christopher ; Foster, Robert E. ;

Petersen, Michael R.

To evaluate 25-gauge pars plana vitrectomy (PPV) for primary repair of

rhegmatogenous retinal detachment

Results: Most patients had pseudophakic RRD (36 [85.7%] of 42 eyes).

The crystalline lens was present in the remaining 6 eyes (14.3%). Of 42
eyes, 28 (66.7%) had macula-on RRD, while 14 (33.3%) had macula-off
RRD. Four surgeons contributed to this study, and 25-gauge PPV
instrumentation, a wide-angle viewing system, endolaser
photocoagulation, and gas tamponade were used in each case. The
single surgery anatomical success rate was 92.9% (39 of 42 eyes). For
eyes with macula-on RRD, best-corrected visual acuity was 20/50 (0.43
logMAR [logarithm of the minimum angle of resolution]) preoperatively
and 20/30 (0.23 logMAR) postoperatively (P = 0.24
 . For eyes with macula-off RRD, best-corrected visual acuity was 5/200
(1.56 logMAR) preoperatively and 20/30 (0.23 logMAR) postoperatively
(P = 0.001). Three eyes required additional surgery for final
reattachment. Final reattachment was achieved in 100% of patients
(mean follow-up, 8 months).

CONCLUSION
25 guage PPV with laser retinopexy,plus gas tamponade is effective for primary
repair of RRD.This single operation has got anatomical success
rate comparable to vitrectomy with primary vitrectomy done with 20 guage
instrumentation,scleral buckling and combined vitrectomy /scleral buckling.
PNEUMATIC RETINOPEXY
 A gas bubble is injected into the vitreous
cavity which closes the tear in the retina.
Subsequently laser or cryotherapy is
performed to treat the edges of the tear.
BRITISH JOURNAL OF OPHTHALMOLOGY,JULY-AUG2006,VOL.9 NO.4

PNEUMATIC RETINOPEXY:SUCCESS RATE AND

COMPLICATIONS

A A ZAIDI,R ALVARADO,A IRVINE

To evaluate the success rate and complications of pneumatic

retinopexy performed at a university hospital and to identify which
patients are best suited for pneumatic Retinopexy
Results:33 of 61 (54%)caseswere successful with a single
procedure.40 of 61(66%)Caseswere success ful with a repeat
injection ofgas or laser retinopexy alone.AllCases had anatomic
success at final followup.age,myopia,lens status,an dno.of breaks
Were not proved to be risk factors for failure.The average duration of
follow up was 15 months.
CONCLUSION
PR was less effective for repair of RRD than most published reports.however,
Repair by scleral buckling or pars plana vitrectomy didn’t influence the visual
Acuity at final follow up.
COMPARISON
SCLERAL BUCKLE VITRECTOMY

1. Minimal conjunctival
1. More conjunctival scarring and
scarring.suitable in glaucoma
external globe manipulation patients who may require
2. This surgery may be more subsequent trabeculectomy
difficult in very high myopes ,filtering surgery
with thin sclera 2. Longer instruments in large
eyes.
3. Cataract is less common.
3. Risk of cataract(depending on
4. Extraocular muscle imbalance pts age)
and induced myopia due to
4. No disturbance within the
globe distortion. muscles and globe is not
5. Peribulbar anaesthesia. distorted.
6. Small gas bubble. 5. Peribulbar anaesthesia
7. Less demand on technology. 6. Large gas bubble
7. High demand on technology and
instrumentation
BRITISH JOURNAL OFOPHTHALMOLOGY,2008,92,148387

23 GUAGE VERSUS 20 GUAGE SYSTEM FOR PARS PLANA

VITRECTOMY:A SYSTEM FOR PROSPECTIVE RANDOMISED
CLINICAL TRIAL.

Aim: To compare the sutureless 23-gauge system with a standard 20-

gauge system in pars plana vitrectomy. .
Results: Conjunctival injection (p = 0.0003) and postoperative pain (p
= 0.01) were significantly reduced following 23-gauge vitrectomy
compared with the 20-gauge procedure. Opening (p = 0.006) and
closure times (p<0.00001) were significantly shorter, and vitrectomy
time (p = 0.001) significantly longer in the 23-gauge system compared
with 20-gauge vitrectomy. However, retinal manipulation and overall
surgery times did not differ significantly between both groups. The
same applies for eye pressure, distance and reading acuity. Regarding
complications, two choroidal haemorrhages and one flat serous
choroidal detachment occurred in the 23-gauge group.

CONCLUSION
23
guage system for Pars plana vitrectomy offers more
GRAEFE’S ARCHIVE FOR CLINICAL AND EXPERIMENTAL
OPHTHALMOLGY,APR 2009,VOL.247,NO.4,PG495-502

WILLIAM GUALTIERI

ONE PORT PLANA VITRECTOMY(25 G MICROINCISION)

A pilot study to test a novel, minimal invasive vitrectomy, through one-

port pars plana sclerotomy, by 25-G instruments, for selected vitreous,
macular and vitreomacular interface disorders

Results All OPPPVs by 25 G were completed as planned.

Anatomical surgical objectives were fulfilled on all eyes; functional
ones on 13 out of 14 eyes. The whole OPPPV group and four of the
phaco OPPPV subset of patients tolerated comfortably less than 30′
surgical time, and three phaco OPPPV ones less than 45′. Full
regimen anti-inflammatory therapy for 2 weeks kept ten eyes out of
14 stable. Post-operatively, two eyes developed a transient alteration
of the intraocular pressure. At the end of the follow-up, neither retinal
detachment nor endophthalmitis occurred.
CONCLUSION

OPPPV by 25 G techniques promise to be an

effective,comfortable, possible office-based alternative
“micro-incisional, minimal invasive vitreous surgery” for
selected vitreous, macula and vitreomacular interface
disorders. Future research on the safety of the OPPPV by
25 G techniques compared to conventional ones is
encouraged.
VITREOUS SUBSTITUTES
 To restore intraocular volume after
drainageof subretinal fluid or vitrectomy
 To hydrokinetically manipulate retina

 To complement the surgical techniques

employed in membrane
dissection(delamination &retinotomy)
 as postoperative adjunct to vitreoretinal
surgery for internal tamponade.
SUBSTANCES USED
INTRAOPERATIVELY
 Balanced salt solution
 Air and other gases
 Viscoelastic fluids(sodium hyaluronate,chondroitin
sulfate,HPMC)
 SILICON LIQUID
 LOW VISCOSITY PFCL(PERFLUORO N OCTANE)

INTRAOCULAR GASES
 xenon
 Air
 Sulfur hexafluoride
 Perfluoroethane
 perfluoropropane
 JOURNAL OF RETINA,MAY 2009,VOL29 ISSUE 5 PG 677-681

Effects of Perfluorocarbon Liquids and Silicone Oil on Human

Retinal Pigment Epithelial Cells and Retinal Ganglion Cells

INOUE, MAIKO MD; IRIYAMA, AYA MD; KADONOSONO,

KAZUAKI MD, PhD; TAMAKI, YASUHIRO MD, PhD;
YANAGI, YASUO MD, PhD

To examine the effects of perfluorocarbon liquid (PFCL) and

silicone oil (SO) on human retinal pigment epithelium (RPE)
cells and retinal ganglion cells (RGCs) in vitro.

Results: Perfluorocarbon liquid affected the survival of ARPE-19 cells

and RGCs when compared with the nontreated control group. ARPE-19
cells decreased significantly after being in contact with PFCL at the
baso-lateral side for 7 days. However, PFCL contact at the apical side
reduced the number of RGCs in a time-dependent manner. In case of
SO, the viability of the ARPE-19 cells decreased significantly after being
in contact with SO at the baso-lateral side for 7 days. However, SO did
not reduce the number of RGCs after a 3-day exposure.
CONCLUSION

Perfluorocarbon liquid is directly toxic to

ARPE-19 cells when exposed to the cells
for 7 days. On the contrary, it seems that
RGCs are damaged in a time-dependent
manner by the more mechanical rather
than toxic effects of PFCL. Silicone oil
seems to exert mechanical rather than
toxic effects on ARPE-19 cells. When
PFCL is used as a postoperative
tamponade clinically, understanding the
difference in the effects will lead to more
effective and safer results.
 CURRENT OPINION IN OPHTHLAMOLOGY 20(3):195-199,
MAY 2009 Spirn, Marc J

COMPARISON OF 25,23 AND 20 GUAGE VITRECTOMY

The history and development of 25-gauge and 23-gauge vitrectomy are

reviewed in this paper and compared with 20-gauge vitrectomy, the historical
gold standard. Current advantages and disadvantages of each are delineated

.
Recent findings: Transconjunctival sutureless vitrectomy continues to offer
advantages of increased patient comfort decreased operative times and
improved postoperative astigmatism. These advantages, however, must be
weighed against the possibility of increased rates of postoperative hypotony
and endopthalmitis.
 CONCLUSION
Both 25-gauge and 23-gauge instruments
continue to evolve, and have improved
significantly since their introductions. Most
cases can now be performed using either
25-gauge or 23-gauge techniques with
success rates comparable to 20-gauge.
Despite these advantages, there are still
cases where 20-gauge is appropriate and
preferable. Clinical experience, innovations
and further studies will help dictate the
future course of pars plana vitrectomy
instrumention
1.15 mm incision 0.55 mm 0.72mm

Requiring suture sutureless sutureless

Inner dia Inner=0.57mm Inner=0.65mm

=0.91mm Outer=0.62mm Outer=0.75mm
Wt(g/4mm)130g 14gm 35gm

2500 cuts/min 1500cuts/min 2500 cuts/min

Distance(tip to 0.33mm 0.23mm
port)=0.43mm
Illumination(xeno 30lumens 37 lumens
n)65 lumens
Increased decreased decreased
incisional
inflammation
Longer visual faster faster
recovery period
Low risk of Known risk Unknown risk
endophthalmitis
ADVANTAGES OF MIVS(23G,25G)
OVER TRADITIONAL
20 G VITRECTOMY
 Sutureless
 Self sealing incisions

 Less conjunctival scarring

 Less corneal astigmatism

 Less operating time

 Less postoperative inflammation

 Rapid visual recovery

 Patient comfort

 Reduced incidence of vitreous

prolapse(cannula system)
LIMITATIONS OF MIVS
 FLEXIBILITY
 LEARNING CURVE

 COST
RECENT DEVELOPMENTS
 Macular translocation
 RPE Transplantation

 Retinal cell transplantation

 Retinal prosthesis

 Stem cell research

 Iris pigment epithelial cell transplantation

 Sustained release ganciclovir

implant(vitrasert)
 Intravitreal
drugs(dexamethasone,triamcinolone)
THANKYOU