25-Gauge vitrectomy for paediatric vitreoretinal conditions

Abstract

This is a retrospective study of 56 eyes of 49 children undergoing vitrectomy with 25-gauge instrumentation. There were no cases of endophthalmitis, wound leaks or hypotony requiring treatment. A modified approach in which the conjunctiva and sclera is sutured was used for young babies requiring a pars plicata approach.

Objective: To evaluate the feasibility and safety of 25-gauge vitrectomy for various vitreoretinal indications in the paediatric population.

Methods: Consecutive patients aged 18 years or less undergoing vitrectomy for various vitreoretinal indications over a 5-year period were studied retrospectively. Two different surgical techniques were used: a modified 25-gauge approach in which the sclerotomies and conjunctiva were sutured as described previously for most children under the age of 1 year, and a transconjunctival 25-gauge approach for older children

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.

Conclusions: 25-gauge vitreoretinal techniques can be used in various paediatric vitreoretinal conditions and facilitate easy access to small spaces in the paediatric eye. To avoid postoperative hypotony, a modified technique is recommended for younger babies in which the conjunctiva and sclera is sutured.