LUCY SCHULTZE

Dr. C.J. Chen examines a patient at the University of Mississippi Medical Center.

The University of Mississippi Medical Center (UMC) is among the first institutions in the nation to begin offering a new vitrectomy procedure that can speed patient recovery and reduce operating time by about 30 percent.

Dr. C.J. Chen, chairman of the UMC Department of Ophthalmology, introduced the newest sutureless 23-gauge vitrectomy in mid-2006 after watching the caliber of instruments mature to make the fine technique possible.

He and his team have performed more than 200 of the procedures so far, reporting their initial results in May at the annual meeting of the Association for Research in Vision and Ophthalmology.

"When people talk about retinal surgery, vitrectomy is considered the longest and most-complicated eye surgery," Chen said. "Now, these improvements will greatly shorten the time we need to spend in the operating room."

The shortened timeframe for surgery means less time the patient must be under anesthesia, he said. The quicker procedure combined with the minimally invasive technique also translates into faster recovery time for patients.

"The patient's comfort level is increased significantly," he said. "Any time when the size of the instrument can be reduced, usually it will create less surgical trauma on the eye.

"Previously, on the second day after surgery, the eye would often be so red and puffy. But with this procedure, in the second day you sometimes cannot even see that the patient had surgery."

In pars plana vitrectomy, the surgeon removes eye fluid that has become clouded or filled with blood and replaces it with a clear fluid. Chen believes the 23-gauge procedure will largely replace the current standard 20-gauge vitrectomy in the coming years for patients with conditions like diabetic retinopathy, retinal detachment and trauma injuries.

The difference is more than just the size of instrument used.

In the traditional procedure, the surgeon enters the eye through three ports — one to infuse fluid into the eye during surgery, one through which the surgeon holds a fiber optic light pipe, and one through which he or she works with a specialized tool to cut and suck away blood and scar tissue.

"This is a very common procedure, and we've done it this way for more than 25 years," Chen said. "It's OK and we do it with good results."

But the problem, he said, is that it requires incisions through both the eye's surface layer, the conjunctiva, and the inner sclera, the white part of the eye — and then requires sutures to close the entry points after surgery.

In contrast, the 23-gauge procedure employs such tiny instruments it typically needs only a little pressure applied to close the entry point. The time saved, largely in the closure stage, has dropped the operating time from about 85 to 90 minutes to 55 to 60 minutes in UMC studies.

Additionally, Chen said, improvements to endoscopic lighting have allowed the use of xenon light in a small-caliber independent probe inserted into the eye wall. Without having to hold the light source in place, the surgeon is able to use both hands to work in the eye when that's necessary for serious cases of diabetic retinopathy.

With Chen leading the new procedure's introduction, the department is passing down the training to a young associate and some of its residents. Chen estimates only 5 to 10 percent of the nation's vitreous and retina surgery community is beginning to use the procedure.

"Not only in retina surgery but also in other areas, everything is downsizing in order to reduce the tissue trauma and speed up the healing for the patient's comfort," he said.


July 2007