A guide to reducing the risk of 25 G surgery

February 1, 2009

Dr Richard Kaiser outlines the recommendations of the microsurgical safety task force.

Key Points

The increasing trend towards microincision surgery is evident across several branches of ophthalmology, vitrectomy surgery included. As with most evolutionary routes, the transition to minimally invasive vitrectomy surgery (MIVS) has not been a smooth one, with new techniques and instruments enjoying their fair share of bad press in recent years.

Endophthalmitis risk too high to ignore

Having read similar reports elsewhere, Dr Kaiser set up the Micro-Surgical Safety Task Force, the aim of the team being to develop a set of recommendations to attempt to reduce the seemingly higher rate of endophthalmitis associated with 25 G vitrectomy. "The task force did not intend to come up with the solution to eliminating all risks associated with 25 G surgery but, between the members, there are a lot of years of experience," remarked Dr Kaiser. The team is comprised of 12 experienced retina surgeons, including George Williams, Antonio Capone, Robert Avery, Harry Flynn, and Ingrid Scott.

According to Dr Kaiser, the answer does not lie in the instrumentation; rather, it lies in the surgical technique.

"Before we put together a list of recommendations, we met several times, for hours at a time. We analyzed the technique in great detail to see if we could identify steps that could be improved or altered in order to reduce the risk of endophthalmitis," said Dr Kaiser.

The recommendations

The team developed recommendations. The following are some of the highlights: