Development of Surgical Treatment for Vitreous Disease


Vitreous surgery has improved remarkably with various advances in surgical instruments and techniques. The two most important breakthrough in recent years have been the introduction of small-gauge pars plana vitrectomy (PPV) systems and new illumination devices. Compared with traditional 20-gauge PPV, sutureless small-gauge PPV appears to be safer, with a shorter operating time, less postoperative inflammation, less patient discomfort, and more rapid recovery of visual acuity. This article reviews recent progress in the surgical management of vitreous disease with a historical perspective.

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T. Mimura, H. Noma and H. Funatsu, "Development of Surgical Treatment for Vitreous Disease," Surgical Science, Vol. 3 No. 11, 2012, pp. 507-513. doi: 10.4236/ss.2012.311101.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] R. Machemer, “A New Concept for Vitreous Surgery. 2. Surgical Technique and Complications,” American Journal of Ophthalmology, Vol. 74, No. 6, 1972, pp. 1022-1033.
[2] R. Machemer and E. W. Norton, “A New Concept for Vitreous Surgery. 3. Indications and Results,” American Journal of Ophthalmology, Vol. 74, No. 6, 1972, pp. 1034-1056.
[3] C. O’Malley and R. M. Heintz Sr., “Vitrectomy with an Alternative Instrument System,” American Journal of Ophthalmology, Vol. 7, No. 4, 1975, pp. 585-588, 591-584.
[4] E. de Juan Jr., and D. Hickingbotham, “Refinements in Microinstrumentation for Vitreous Surgery,” American Journal of Ophthalmology, Vol. 109, No. 2, 1990, pp. 218-220.
[5] G. F. Hilton, R. G. Josephberg, L. S. Halperin, S. A. Madreperla, D. A. Brinton, S. S. Lee and S. F. Gordon, “Office-based Sutureless Transconjunctival Pars Plana Vitrectomy,” Retina, Vol. 22, No. 6, 2002, pp. 725-732. doi:10.1097/00006982-200212000-00007
[6] C. Eckardt, “Transconjunctival Sutureless 23-Gauge Vitrectomy,” Retina, Vol. 25, No. 2, 2005, pp. 208-211. doi:10.1097/00006982-200502000-00015
[7] G. Y. Fujii, E. De Juan Jr., M. S. Humayun, D. J. Pieramici, T. S. Chang, C. Awh, E. Ng, A. Barnes, S. L. Wu and D. N. Sommerville, “A New 25-Gauge Instrument System for Transconjunctival Sutureless Vitrectomy Surgery,” Ophthalmology, Vol. 109, No. 10, 2002, pp. 1807-1813.
[8] G. Y. Fujii, E. De Juan Jr., M. S. Humayun, T. S. Chang, D. J. Pieramici, A. Barnes and D. Kent, “Initial Experience Using the Transconjunctival Sutureless Vitrectomy System for Vitreoretinal Surgery,” Ophthalmology, Vol. 109, No. 10, 2002, pp. 1814-1820. doi:10.1016/S0161-6420(02)01119-3
[9] K. G. Au Eong, G. Y. Fujii, J. E. de Jr., P. S. Jensen, D. N. Sommerville, T. H. Shelley, A. C. Barnes and M. Maia, “A New Three-Port Cannular System for Closed Pars Plana Vitrectomy,” Retina, Vol. 22, No. 1, 2002, pp. 130-132. doi:10.1097/00006982-200202000-00032
[10] Y. Oshima, C. C. Awh and Y. Tano, “Self-Retaining 27-Gauge Transconjunctival Chandelier Endoillumination for Panoramic Viewing during Vitreous Surgery,” American Journal of Ophthalmology, Vol. 143, No. 1, 2007, pp. 166-167. doi:10.1016/j.ajo.2006.07.051
[11] Y. Oshima, T. Wakabayashi, T. Sato, M. Ohji and Y. Tano, “A 27-Gauge Instrument System for Transconjunctival Sutureless Microincision Vitrectomy Surgery,” Ophthalmology, Vol. 117, No. 1, 2010, pp. 93-102. doi:10.1016/j.ophtha.2009.06.043
[12] E. Chen, “25-Gauge Transconjunctival Sutureless Vitrectomy,” Current Opinion in Ophthalmology, Vol. 18, No. 3, 2007, pp. 188-193. doi:10.1097/ICU.0b013e328133889a
[13] S. K. Warrier, R. Jain, J. S. Gilhotra and H. S. Newland, “Sutureless Vitrectomy,” Indian Journal of Ophthalmology, Vol. 56, No. 6, 2008, pp. 453-458. doi:10.4103/0301-4738.43364
[14] M. J. Spirn, “Comparison of 25, 23 and 20-Gauge Vitrectomy,” Current Opinion in Ophthalmology, Vol. 20, No. 3, 2009, pp. 195-199. doi:10.1097/ICU.0b013e328329eaea
[15] T. Sandinha, C. de Souza, R. Essex, T. L. Kelly, S. Lake and R. Phillips, “Revisiting Transconjunctival Sutureless 25-Gauge Vitrectomy: Still Worthwhile?” Clinical & Experimental Ophthalmology, Vol. 37, No. 7, 2009, pp. 649-653. doi:10.1111/j.1442-9071.2009.02116.x
[16] F. M. Recchia, I. U. Scott, G. C. Brown, M. M. Brown, A. C. Ho and M. S. Ip, “Small-Gauge Pars Plana Vitrectomy: A Report by the American Academy of Ophthalmology,” Ophthalmology, Vol. 117, No. 9, 2010, pp. 1851-1857. doi:10.1016/j.ophtha.2010.06.014
[17] I. D. Fabian and J. Moisseiev, “Sutureless Vitrectomy: Evolution and Current Practices,” British Journal of Ophthalmology, Vol. 95, No. 3, 2011, pp. 318-324. doi:10.1136/bjo.2009.176495
[18] P. E. Cleary, “The Treatment of Advanced Diabetic Eye Disease,” Irish Journal of Medical Sciences, Vol. 148 No. S2, 1979, pp. 38-44.
[19] B. D. McCary, C. S. Daniel and K. H. Edwards, “System Enhancements Bring Added Safety, Efficiency and Ease- of-Use to 25-Gauge Vitrectomy,” Bausch & Lomb Incorporated, SU-4024, 2004.
[20] O. Magalhaes Jr., L. Chong, C. DeBoer, P. Bhadri, R. Kerns, A. Barnes, S. Fang and M. Humayun, “Vitreous Dynamics: Vitreous Flow Analysis in 20-, 23-, and 25-Gauge Cutters,” Retina, Vol. 28, No. 2, 2008, pp. 236- 241. doi:10.1097/IAE.0b013e318158e9e0
[21] O. Magalhaes Jr., M. Maia, A. Maia, F. Penha, E. Dib, M. E. Farah and P. Schor, “Fluid Dynamics in Three 25-Gauge Vitrectomy Systems: Principles for Use in Vitreoretinal Surgery,” Acta Ophthalmol, Vol. 86, No. 2, 2008, pp. 156-159. doi:10.1111/j.1600-0420.2007.00988.x
[22] J. P. Hubschman, A. Gupta, D. H. Bourla, M. Culjat, F. Yu and S. D. Schwartz, “20-, 23-, and 25-Gauge Vitreous Cutters: Performance and Characteristics Evaluation,” Retina, Vol. 28, No. 2, 2008, pp. 249-257. doi:10.1097/IAE.0b013e31815ec2b3
[23] J. P. Hubschman, J. L. Bourges, I. Tsui, S. Reddy, F. Yu and S. D. Schwartz, “Effect of Cutting Phases on Flow Rate in 20-, 23-, and 25-Gauge Vitreous Cutters,” Retina, Vol. 29, No. 9, 2009, pp. 1289-1293. doi:10.1097/IAE.0b013e3181acd3a9
[24] S. Y. Fang, C. M. DeBoer and M. S. Humayun, “Performance Analysis of New-Generation Vitreous Cutters,” Graefe’s Archive for Clinical and Experimental Ophthalmology, Vol. 246, No. 1, 2008, pp. 61-67. doi:10.1007/s00417-007-0672-8
[25] T. Sato, S. Kusaka, Y. Oshima and T. Fujikado, “Analyses of Cutting and Aspirating Properties of Vitreous Cutters with High-Speed Camera,” Retina, Vol. 28, No. 5, 2008, pp. 749-754. doi:10.1097/IAE.0b013e3181631907
[26] A. Teixeira, L. P. Chong, N. Matsuoka, L. Arana, R. Kerns, P. Bhadri and M. Humayun, “Vitreoretinal Traction Created by Conventional Cutters during Vitrectomy,” Ophthalmology, Vol. 117, No. 7, 2010, pp. 1387-1392. doi:10.1016/j.ophtha.2009.11.004
[27] T. Altan, N. Acar, Z. Kapran, Y. B. Unver and S. Ozdogan, “Transconjunctival 25-Gauge Sutureless Vitrectomy and Silicone Oil Injection in Diabetic Tractional retinal Detachment,” Retina, Vol. 28, No. 9, 2008, pp. 1201-1206. doi:10.1097/IAE.0b013e3181853d3c
[28] G. A. Peyman, “Improved Vitrectomy Illumination System,” American Journal of Ophthalmology, Vol. 81, No. 1, 1976, pp. 99-100.
[29] E. H. Ryan Jr., “Two Shielded Bullet’ Probes for Panoramic Endoillumination,” Archives of Ophthalmology, Vol. 115, No. 1, 1997, pp. 125-126. doi:10.1001/archopht.1997.01100150127028
[30] G. A. Peyman, C. Canakis, C. Livir-Rallatos and J. Easley, “A New Wide-Angle Endoillumination Probe for Use during Vitrectomy,” Retina, Vol. 22, No. 2, 2002, p. 242. doi:10.1097/00006982-200204000-00025
[31] C. Eckardt, “Twin Lights: A New Chandelier Illumination for Bimanual Surgery,” Retina, Vol. 23, No. 6, 2003, pp. 893-894. doi:10.1097/00006982-200312000-00039
[32] C. Eckardt, T. Eckert and U. Eckardt, “27-Gauge Twin-light Chandelier Illumination System for Bimanual Transconjunctival Vitrectomy,” Retina, Vol. 28, No. 3, 2008, pp. 518-519. doi:10.1097/IAE.0b013e3181607a0f
[33] Y. Oshima, D. R. Chow, C. C. Awh, H. Sakaguchi and Y. Tano, “Novel mercury Vapor Illuminator Combined with a 27/29-Gauge Chandelier Light Fiber for Vitreous Surgery,” Retina, Vol. 28, No. 1, 2008, pp. 171-173. doi:10.1097/IAE.0b013e31814fb0d3
[34] R. Sorcinelli, “Surgical Management of Epiretinal Membrane with Indocyanine-Green-Assisted Peeling,” Ophthalmologica, Vol. 217, No. 2, 2003, pp. 107-110. doi:10.1159/000068556
[35] A. K. Kwok, T. Y. Lai, W. W. Li, D. C. Woo and N. R. Chan, “Indocyanine Green-Assisted Internal Limiting Membrane Removal in Epiretinal Membrane Surgery: A Clinical and Histologic Study,” American Journal of Ophthalmology, Vol. 138, No. 2, 2004, pp. 194-199. doi:10.1016/j.ajo.2004.03.013
[36] K. Kwok, T. Y. Lai, W. W. Li, D. T. Yew and V. W. Wong, “Trypan Blue- and Indocyanine Green-Assisted Epiretinal Membrane Surgery: Clinical and Histopathological Studies,” Eye (Lond), Vol. 18, No. 9, 2004, pp. 882-888. doi:10.1038/sj.eye.6701359
[37] A. K. H. Kwok, T. Y. Lai and K. S. Yuen, “Epiretinal Membrane Surgery with or without Internal Limiting Membrane Peeling,” Clinical & Experimental Ophthalmology, Vol. 33, No. 4, 2005, pp. 379-385. doi:10.1111/j.1442-9071.2005.01015.x
[38] S. K. Gibran, B. Flemming, T. Stappler, I. Pearce, C. Groenewald, H. Heimann, P. Hiscott and D. Wong, “Peel and Peel Again,” British Journal of Ophthalmology, Vol. 92, No. 3, 2008, pp. 373-377. doi:10.1136/bjo.2007.129965
[39] C. Haritoglou, A. Gandorfer, M. Schaumberger, S. G. Priglinger, A. J. Mueller, C. A. Gass and A. Kampik, “Trypan Blue in Macular Pucker Surgery: An Evaluation of Histology and Functional Outcome,” Retina, Vol. 24, No. 4, 2004, pp. 582-590. doi:10.1097/00006982-200408000-00012
[40] C. Haritoglou, K. Eibl, M. Schaumberger, A. J. Mueller, S. Priglinger, C. Alge and A. Kampik, “Functional Outcome after Trypan Blue-Assisted Vitrectomy for Macular Pucker: A Prospective, Randomized, Comparative trial,” American Journal of Ophthalmology, Vol. 138, No. 1, 2004, pp. 1-5. doi:10.1016/j.ajo.2004.03.005
[41] D. Tognetto, S. Zenoni, G. Sanguinetti, C. Haritoglou and G. Ravalico, “Staining of the Internal Limiting Membrane with Intravitreal Triamcinolone Acetonide,” Retina, Vol. 25, No. 4, 2005, pp. 462-467. doi:10.1097/00006982-200506000-00011
[42] H. Enaida, T. Hisatomi, Y. Hata, A. Ueno, Y. Goto, T. Yamada, T. Kubota and T. Ishibashi, “Brilliant Blue G Selectively Stains the Internal Limiting Membrane/Brilliant Blue G-Assisted Membrane Peeling,” Retina, Vol. 26, No. 6, 2006, pp. 631-636.
[43] H. Shimada, H. Nakashizuka, T. Hattori, R. Mori, Y. Mizutani and M. Yuzawa, “Double Staining with Brilliant Blue G and Double Peeling for Epiretinal Membranes,” Ophthalmology, Vol. 116, No. 7, 2009, pp. 1370-1376. doi:10.1016/j.ophtha.2009.01.024

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