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BMC Ophthalmology

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Open Access 01-12-2020 | Vitrectomy | Research article

Microincision vitrectomy surgery: experimental visualization and quantification of vitreous contamination

Authors: Yumiko Machida, Hiroyuki Nakashizuka, Jun Shoji, Hiroyuki Shimada

Published in: BMC Ophthalmology | Issue 1/2020

Abstract

Background

To visualize and quantify vitreous contamination following microincision vitrectomy surgery (MIVS) using an experimental vitreous contamination model (EVCM).

Methods

Enucleated porcine eyes with fluoresbrite carboxylate microspheres applied to the conjunctival surface were used as a type 1 EVCM. Twenty-five- or 27-gauge (G) trocar cannulas were inserted through the conjunctiva and sclera, followed by the placing and opening of an infusion cannula. These procedures were monitored by an intraocular fiber catheter. Secondly, condensed microspheres were applied to an excised sheet of porcine sclera to serve as type 2 EVCM. Twenty-five- or 27-G trocar cannulas were inserted perpendicularly through the top of the sclera where the condensed microspheres were applied, an infusion cannula was inserted, 0.1 mL of saline solution injected through the infusion cannula, and samples collected. The fluorescence strength of samples was then measured using fluorophotometry.

Results

We visually detected fluorescent microspheres in 10/10 eyes with 25-G and 10/10 with 27-G MIVS. In the experimental quantification study, each MIVS gauge value was significantly higher than the control (P < 0.01). However, there was no significant difference between 25-G and 27-G MIVS.

Conclusions

MIVS carries the risk of introducing contamination directly into the eyes when the trocar cannula is inserted and infusion cannula is opened, even when a 27-G MIVS is used. Our study has shown it is essential that the surgeon be aware of the possibility of introducing contamination from the conjunctiva at all times during MIVS.

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Kunimoto DY, Kaiser RS, Wills Eye Retina Service. Incidence of endophthalmitis after 20- and 25-gauge vitrectomy. Ophthalmology. 2007;114:2133–7. https://doi.org/10.1016/j.ophtha.2007.08.009.CrossRefPubMed

Scott IU, Flynn HW, Dev S, Shaikh S, Mittra RA, Arevalo JF, Kychenthal A, Acar N. Eedophthalmitis after 25-gauge and 20-gauge pars plana vitrectomy. Retina. 2008;28:138–42. https://doi.org/10.1097/IAE.0b013e31815e9313.CrossRefPubMed

Oshima Y, Wakabayashi T, Sato T, Ohji M, Tano Y. A 27-gauge instrument system for transconjunctival sutureless microincision vitrectomy surgery. Ophthalmology. 2010;117:93–102.e2. https://doi.org/10.1016/j.ophtha.2009.06.043.CrossRefPubMed

Tominaga A, Oshima Y, Wakabayashi T, Sakaguchi H, Hori Y, Maeda N. Bacterial contamination of the vitreous cavity associated with transconjunctival 25-gauge microincision vitrectomy surgery. Ophthalmology. 2010;117:811–817.e1. https://doi.org/10.1016/j.ophtha.2009.09.030.CrossRefPubMed

Nakashizuka H, Shoji J, Shimada H, Yuzawa M. Experimental visualization and quantification of vitreous contamination following intravitreal injection. Retina. 2016;36:1882–7. https://doi.org/10.1097/IAE.0000000000001028.CrossRefPubMed

Inoue Y, Usui M, Ohashi Y, Shiota H, Yamazaki T. Preoperative disinfection of the conjunctival sac with antibiotics and iodine compounds: a prospective randomized multicenter study. Jpn J Ophthalmol. 2008;52:151–61. https://doi.org/10.1007/s10384-008-0517-y.CrossRefPubMed

Speaker MG, Milch FA, Shah MK, Eisner W, Kreiswirth BN. Role of external bacterial flora in the pathogenesis of acute postoperative endophthalmitis. Ophthalmology. 1991;98:639–49. https://doi.org/10.1016/s0161-6420(91)32239-5.CrossRefPubMed

Hatano H, Sasaki T, Tanaka N. Pseudomonas endophthalmitis in rabbits--intravitreal inoculation of two pseudomonal strains. Nihon Ganka Gakkai Zasshi. 1988;92:1758–64.PubMed

Fujii GY, De Juan E Jr, Humayun MS, Pieramici DJ, Chang TS, Awh C, Ng E, Barnes A, Wu SLSD. A new 25-gauge instrument system for transconjunctival sutureless vitrectomy surgery. Ophthalmology. 2002;109:1807–12. https://doi.org/10.1016/S0161-6420(02)01179-X.CrossRefPubMed

10.

Shimada H, Nakashizuka H, Hattori T, Mori R, Mizutani Y, Yuzawa M. Reduction of vitreous contamination rate after 25-gauge vitrectomy by surface irrigation with 0.25% povidone-iodine. Retina. 2013;33:143–51. https://doi.org/10.1097/IAE.0b013e318261a6ce.CrossRefPubMed

11.

Shimada H, Nakashizuka H, Hattori T, Mori R, Mizutani Y, Yuzawa M. Conjunctival displacement to the corneal side for oblique-parallel insertion in 25-gauge vitrectomy. Eur J Ophthalmol. 2008;18:848–51. https://doi.org/10.1177/112067210801800535.CrossRefPubMed

12.

Shimada H, Nakashizuka H, Mori R, Mizutani Y, Hattori T. 25-gauge scleral tunnel transconjunctival vitrectomy. Am J Ophthalmol. 2006;142:871–3. https://doi.org/10.1016/j.ajo.2006.05.057.CrossRefPubMed

13.

Oshima Y, Kadonosono K, Yamaji H, Inoue M, Yoshida M, Kimura H, Ohji M, Shiraga F, Hamasaki T. Japan Microincision Vitrectomy Surgery Sttudy Group. Multicenter survey with a systematic overview of acute-onset endophthalmitis after transconjunctival microincision vitrectomy surgery. Am J Ophthalmol. 2010;150:716–725.e1. https://doi.org/10.1016/j.ajo.2010.06.002.CrossRefPubMed

14.

Nicoli S, Ferrari G, Quarta M, Macaluso C, Govoni P, Dallatana D, Stanti P. Porcine sclera as a model of human sclera for in vitro transport experiments: histology, SEM, and comparative permeability. Mol Vis. 2009;15:259–66.PubMedPubMedCentral

Title: Microincision vitrectomy surgery: experimental visualization and quantification of vitreous contamination
Authors: Yumiko Machida
Hiroyuki Nakashizuka
Jun Shoji
Hiroyuki Shimada
Publication date: 01-12-2020
Publisher: BioMed Central
Keyword: Vitrectomy
Published in: BMC Ophthalmology / Issue 1/2020
Electronic ISSN: 1471-2415
DOI: https://doi.org/10.1186/s12886-020-01712-6

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Microincision vitrectomy surgery: experimental visualization and quantification of vitreous contamination

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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