Pulak Agarwal, Shorya Azad, Vinod Agarwal

Purpose: To evaluate intra-operative limitations and difficulty of 27 gauge vitrectomy in complex vitreo-retinal pathologies.
Methods: It is a retrospective analysis of all patients undergoing 27 gauge (valved) vitrectomy over a period of I month by a single surgeon(SVA). A total of 11 patients inclusive of Diabetic TRD (5), Primary RRD(4) and ROP(2) were analyzed. Standard three port pars plana vitrectomy (PPV) was performed +/- gas or oil injection. During the surgery difficulty while performing the routine steps were noted in each subset of patients.
Results: All patients underwent successful surgery. Difficulty/limitations noted during diabetic PPV were during segmentation of thicker membranes (3/5) and diathermy of bleeders(2/5). During PPV for RRD, PVD induction till ora (2/4) and peripheral vitrectomy (3/4) were difficult steps noted. Surgery for ROP was difficult due to inaccuracy of intended cutter move- ments (1/2) and vitrectomy (2/2). Universal limitation to all surgeries were difficulty in insertion of flute nee- dle through the cannula (11/11), bending of instru- ments (11/11) and silicone oil insertion (5/5).
Conclusion: Smaller gauge and lesser rigidity of cur- rently available 27 gauge instruments may lead to diffi- culty during routine steps in complex vitreo-retinal pathologies. However, successful surgery can be per- formed by circumventing these limitations by experience.