Foreword 1 (German Edition)
In 2002 when the team of Eugene de Juan, Los Angeles, published their first experience of the transconjunctival sutureless vitrectomy with 25-gauge instruments, it could not be foreseen that the “small gauge vitrectomy” would become the new standard procedure of vitrectomy within a few years.
Most retinal surgeons had previously considered the conjunctiva and sclera in a 20-gauge vitrectomy as a more or less troublesome and time-consuming obstacle before and after their true passion, the vitreous cavity. The extensive opening of the conjunctiva in conventional 20-gauge vitrectomy, the suture material used for the closure of sclera and conjunctiva and the sometimes wide-scale application of diathermy resulted often in a pronounced trauma of the outer layers of the eye. Thus, any revisional surgery became increasingly difficult due to the increased scarring of conjunctiva and Tenon’s capsule and the atrophy of the sclera in the pars plana.
Due to their flexibility, the first 25-gauge instruments were initially only used for relatively simple vitreoretinal surgery at the posterior pole. However, the minimally invasive approach by de Juan was from the beginning fascinating, because not only was the extraocular part of a vitrectomy significantly shortened, but the trauma of conjunctiva and sclera were also significantly reduced.
In 2004, inspired by de Juan’s method, Claus Eckardt developed a trocar cannula system and instruments with a diameter of 23-gauge in Frankfurt-Höchst. This invention had on one side the advantage of the 25-gauge vitrectomy and on the other side the efficiency of the 20-gauge instruments. The aim was to carry out all possible vitreoretinal surgery with the same instrumentarium, and this has since then become reality in our department.
A key to the success of the 23-gauge technology step has been Claus Eckardt’s concept of a tangential insertion of the trocars and the use of valves for the cannulas: Due to the tunnel-shaped incision technique within the sclera, an intraoperatively stable positioning of the cannulas and a sutureless closure of the sclerotomies after removal of the cannulas, postoperative hypotension or even endophthalmitis could be prevented. The valves allow a vitrectomy in a closed system and reduce the flow of infusion fluid through the vitreous cavity.
Ulrich Spandau presents in this very practical book on 23-gauge vitrectomy the latest equipment and instruments needed for a 23-gauge vitrectomy and he explains in detail the most important surgical techniques.
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Foreword 1 (German Edition) |
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A lot of useful tips, and last but not least the included DVD with a variety of surgical videos, make this book a very useful surgical compendium.
This practical book will be a great guide for young ophthalmic surgeons who want to familiarize themselves with modern vitrectomy.
Even experienced vitreoretinal surgeons, who wish to switch from 20-gauge to 23-gauge vitrectomy, will benefit from this compendium.
Frankfurt-Höchst, Germany |
Tillmann Eckert |
Foreword 2
Dr. Ulrich Spandau confirms with this compendium to be the most dedicated of my so far eight fellows in vitreoretinal surgery. He presents here our current surgical concept, instrumentation and operative techniques that have been developed in Uppsala in the last 17 years. It is a transconjunctival, 23-gauge Microincision Vitrectomy Surgery (MIVS), combined with phaco-emulsification in elderly patients, performed bimanually for the most of complex indications. To the best of my knowledge no comparable practical guide for current vitreoretinal surgery has been published since Zivojnovic’s Silicone Oil in Vitreoretinal Surgery, in 1987. Since then vitreoretinal surgery has changed very much, from 20-gauge macroincisional vitrectomy with silicone oil tamponade in most of the cases, to 23-gauge microincisional, bimanual vitrectomy with gas tamponade that we use today.
Dr. Spandau has opened a treasure box that he has filled patiently for several years and presents here some genuine surgical pearls, both those that he has discovered for himself, those that we have discussed together, those that I have shown him and furthermore those that were known since before. That gives an opportunity to both beginners and more experienced vitreoretinal surgeons to improve their practical knowledge and refine their procedures in this field. It is our duty to share all the surgical skills and knowledge with each other in order to provide the best results for our patients. This book is a genuine account of our practical work dedicated to them, which Dr. Spandau has written in collaboration with Dr. Heinrich Heimann. Thank you Ulrich and Heinrich!
Dr. Zoran Tomic
Chief Vitreoretinal Surgeon
Department of Ophthalmology
University Hospital
Uppsala, Sweden
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