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DOI: 10.1055/s-2007-963518
© Georg Thieme Verlag KG Stuttgart · New York
Möglichkeiten und Grenzen der innovativen Vitrektomiesysteme
Scope and Limititions of Innovative Vitrectomy SystemsPublikationsverlauf
Eingegangen: 5.7.2007
Angenommen: 9.8.2007
Publikationsdatum:
10. September 2007 (online)

Zusammenfassung
Ziel: Ziel der vorliegenden Arbeit ist es, - nach Darstellung eines kurzen geschichtlichen Überblickes zur Entwicklung der Vitrektomiesysteme - die innovativen 25-Gauge- und 23-Gauge-Vitrektomiesysteme anhand der derzeit vorliegenden klinischen Studien und Fallberichte insbesondere unter den Aspekten Funktionalität, Sicherheit und Effizienz zu betrachten. Methoden: In einem Cluster von verschiedenen relevanten medizinischen Datenbanken (XMedall; XPharmall) wurde eine Literaturrecherche durchgeführt. Schwerpunkt bei der Recherche lag auf Publikationen zum Thema Entwicklung und Stand der Pars-plana-Vitrektomie (ppV). Insbesondere wurden klinische Studien und Fallberichte zur ppV mit 20-, 23- und 25-Gauge-Techniken verfolgt. Es wurden nur deutsche und englische Publikationen ab 1966 berücksichtigt. Anschließend wurde eine deskriptive Auswertung der relevanten Studien vorgenommen. Ergebnis: 25-Gauge- und 23-Gauge-Vitrektomiesysteme tragen zu einer Verkürzung der Operationsdauer bei und sind gleichzeitig weniger invasiv. Beide Systeme sind grundsätzlich als sicher und effizient zu bewerten. Postoperative Komplikationen nach 25-Gauge-Vitrektomie sind denen nach 20-Gauge-Vitrektomie vergleichbar. Im Vergleich zu 23-Gauge- und 20-Gauge-Instrumenten weisen die 25-Gauge-Instrumente eine wesentlich höhere Flexibilität auf, erfordern daher eine besondere Lernphase für den Operateur und sind nicht für alle Indikationen geeignet. Das 23-Gauge-System kann aufgrund seiner - im Vergleich zu 25-Gauge-Instrumenten - größeren Instrumentenstabilität und des erhöhten Volumendurchflusses diese Nachteile überwinden. Allerdings kann die Verwendung von Silikonöl bei der 23-Gauge-Vitrektomie möglicherweise zu Undichtigkeiten der Sklerotomien führen und einen Nahtverschluss erfordern. Schlussfolgerung: Während sowohl 25-Gauge- als auch 23-Gauge-Vitrektomiesysteme einen schnelleren und weniger invasiven Eingriff ermöglichen, werden die Nachteile der 25-Gauge-Systeme - hohe Instrumentenflexibilität und eingeschränkter Volumendurchfluss - durch die 23-Gauge-Systeme überwunden. Möglicherweise kann die 23-Gauge-Vitrektomie aufgrund ihres breiteren Anwendungsbereiches im Vergleich zu 25-Gauge die 20-Gauge-Vitrektomie zukünftig weitgehend ersetzen und neuer Vitrektomiestandard werden.
Abstract
Purpose: The aim of the present article is to review the methodical and technological development of pars plana vitrectomy. Special attention is drawn to safety, efficiency and functionality of the innovative 25-gauge und 23-gauge vitrectomy systems which are compared to the standard 20-gauge vitrectomy system. This was done based on clinical studies and case reports. Methods: A literature search was conducted in a cluster of different medical databases (XMedall; XPharmall). Focus of the research was the “development” and “status quo” of pars plana vitrectomy. In particular, clinical studies and case reports dealing with safety and efficiency of 20-, 23- and 25-gauge vitrectomy systems have been evaluated. Only peer-reviewed articles from 1966 until today were investigated. Finally, a descriptive analysis of the relevant studies was made. Results: Both innovative vitrectomy systems are safe and effective and help to reduce operating time. There was no significant difference in postoperative complications following 25-gauge vitrectomy and 20-gauge vitrectomy. 25-gauge instruments, however, show a greater flexibility. For this reason a certain learning curve is required and the range of application is limited. Due to its greater stiffness and larger diameter, the 23-gauge system - while still allowing a transconjunctival access - may overcome the disadvantages of the 25-gauge system. However, the use of silicone oil may lead to leakage of the sclerotomies and thus necessitate additional suturing. Conclusion: The use of both innovative vitrectomy systems offers the advantage of a faster and less invasive surgical procedure. However, there are disadvantages which limit the indications for 25-gauge vitrectomy. The 23-gauge vitrectomy may overcome these disadvantages and - due to its wider range of application - may be used instead of conventional 20-gauge vitrectomy in most cases. It may therefore become the new standard for vitrectomy.
Schlüsselwörter
Pars-plana-Vitrektomie - transkonjunktivale nahtlose Vitrektomie - 23-Gauge - 25-Gauge - 20-Gauge - Instrumentarium - Sicherheit - Effizienz - Komplikation
Key words
pars plana vitrectomy - transconjunctival sutureless vitrectomy - 20-gauge - 23-gauge - 25-gauge - instrumentation - complication - safety - efficiency
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