To view this page ensure that Adobe Flash Player version 11.1.0 or greater is installed.

Vitreoretina Micro-incision Vitrectomy Surgery – Past, Present and Future Manish Nagpal, 1 Amrita Verma 2 and Sangeeta Goswami 3 1. Consultant Vitreoretinal Surgeon; 2. Fellow in Retina and Vitreous; 3. Fellow, Retina Foundation, Ahmedabad, India Abstract The advent of micro-incision vitrectomy surgery (MIVS) changed the approach, indications and complications of vitreoretinal surgeries forever. Since its introduction in 2002, MIVS has been gaining popularity amongst retinal surgeons for managing a wide variety of vitreoretinal disorders. MIVS allows for more efficient surgery, faster recovery time and better visual outcomes than 20G vitrectomy. The use of instrumentation having small diameters reduced trauma from conjunctival and scleral manipulation as well as post-operative inflammation and corneal astigmatism. Further refinement of techniques with the introduction of 27G for routine procedures increases the comfort for the patient and minimises the recovery time. In this review, we briefly summarise the journey of MIVS to its present status and discuss the various advances that have taken place to achieve better efficiency and results. Keywords MIVS, 27G vitrectomy, history-MIVS, wound construction in MIVS, sutureless vitrectomy Disclosure: Manish Nagpal, Amrita Verma and Sangeeta Goswami have no conflicts of interest to declare. No funding was received in the publication of this article. Open Access: This article is published under the Creative Commons Attribution Noncommercial License, which permits any non-commercial use, distribution, adaptation and reproduction provided the original author(s) and source are given appropriate credit. Received: 3 March 2015 Accepted: 25 March 2015 Citation: European Ophthalmic Review, 2015;9(1):64–68 Correspondence: Manish Nagpal, Retina Foundation, Near Shahibag Underbridge, Shahibag, Ahmedabad, India. E: drmanishnagpal@yahoo.com Small is big in the world of ocular surgeries. As anterior surgeons moved from regular phacoemulsification to phaconit, the advent of micro- incision vitrectomy surgery (MIVS) changed the approach, indications and complications of vitreoretinal surgeries forever. Since its introduction in 2002, 1 MIVS has been gaining popularity amongst retinal surgeons for managing a wide variety of vitreoretinal disorders. MIVS allows for more efficient surgery, faster recovery time, reduced post-operative inflammation and better visual outcomes than 20G vitrectomy. 2–5 As with any technology, it has its own pros and cons. But the pros outweigh the cons enough to have made this cutting-edge innovation the first choice of retinal surgeons worldwide. It is a constantly growing field, seeing ever newer micro-instrumentation and ever fewer side effects. Its safety, advantages and disadvantages have been proved in multiple studies. 6 Thus a constant update of knowledge and skill is now needed to provide the best possible care to patients. Historical Aspect The surgical techniques of pars plana vitrectomy (PPV) have significantly refined since the first description of the procedure by Machemer et al. in the early 1970s. 7,8 Machemer developed the vitreous infusion suction cutter (VISC), 17G (1.42 mm in diameter), which needed a 2.30  mm sclerotomy port. In 1974, O’Malley et al. refined the technique by introducing the three- port 20G (0.91 mm) approach through the sclera, after a partial dissection of the conjunctiva. 9 At the end of the procedure, the sclerotomies and the conjunctiva were sutured with absorbable sutures, which, with time, became the cornerstone of vitrectomy procedures. 64 In 1990, De Juan developed a 25G instrument set for paediatric use, since the conventional 20G cutters proved too large, lacking precision and unsuitable for paediatric use. 10 However, De Juan and others stated that because of reduced aspiration rate, 25G vitrectomy was to be used only in selected delicate cases requiring particularly precise and careful intervention. Novel attempts to shorten surgical time and trauma led to considerable improvement in surgical techniques and equipment and eventually led to the development of the first 20G transconjunctival sutureless approach by Chen et al. 11 in 1996. The 20G sutureless technique, however, did not gain much popularity due to high rates of wound leak, choroidal detachment and need for suture placement in many cases. 12 Eventually, in 2002, a complete 25G (0.51 mm) transconjunctival vitrectomy system was introduced by Fujii et al. consisting of microtrocar cannulas affording ease as well as safety of instrument introduction and withdrawal, along with an array of integrated 25G instruments. 1,13,14 Three years later, Eckardt et al. introduced a 23G (0.61 mm) system. 15 Oshima et al. introduced further miniaturisation of the technique by means of a 27G sutureless vitrectomy system. 16 Wound Construction The standard system, which required conjunctival incisions and sclerotomies of 0.89 mm diameter (20G), has been made smaller and less traumatic. The use of a trocar and cannula system causes less disruption of the conjunctiva and sclera, and the incisions themselves Tou c h ME d ica l ME d ia