the 25-gauge curved vitrectomy probe was a prototype 
 manufactured by bausch and lomb ( rochester , ny ) .
the length of 
 the probe is 25 mm with a uniform 25-g diameter ( 0.5 mm ) . 

construction of the illuminated vitrectomy probe is similar 
 to that described previously with a 20-g vitrectomy probe.5 
 a seamless strong polyester ( polyethylene terephthalate ) heat 
 shrunk tubing ( advanced polymers , inc .
salem , nh ) is used 
 to secure a fiberoptic endoilluminator with a curved 25-g 
 vitrector ( [ fig .
1a , b , and 2a ] : vitrector and em).6 the tubing 
 has an internal diameter of 0.05 inches and thickness of 0.0005 
 inches .
the resultant illuminated vitrector has a diameter of 
 1.0 mm ( 0.5 mm fiberoptic light source + 0.5 mm 25-g vitrector ) 
 [ fig .
the assembly is sterilized with gamma radiation , 
 ethylene oxide or cold gas sterilization .
standard surgical technique with microvitreoretinal blade is 
 used to create the sclerotomies.7 the posterior ppv is completed 
 using a 20-g vitrector . at the end of the procedure the 20-g 
 cutter is replaced with the 25-g illuminated curved vitrector 
 [ fig . 3 ] .
the illumination of the probe facilitates visualization 
 of the vitreous on the opposite vitreous base ( 180 away ) , while 
 the curved design of the probe avoids crystalline lens touch 
 [ figs . 4 , 5 ] .
this allows the surgeon to use the other hand to 
 depress the opposite sclera , which enables viewing of the 
 internal sclerotomy with its surrounding vitreous through the 
 wide - angle lens system [ fig .
position of the endoilluminator 
 tip from the vitrector port can be varied by a gentle sliding 
 maneuver during the surgery to optimize the illumination 
 of the incarcerated vitreous .
the vitreous incarcerated in the 
 internal sclerotomy opening is shaved completely under direct 
 visualization .
excision of the peripheral vitreous in a phakic eye with a 
 clear lens is one of the most challenging tasks in vitreoretinal 
 surgery . with the advent of the wide - angle viewing systems , 
 visualization of the peripheral vitreous base
the potential of iatrogenic trauma to the posterior 
 lens surface by the straight vitrectomy probe restricts access 
 to the peripheral vitreous near the sclerotomy site.8 a curved 
 instrument allows access to the internal sclerotomy site without 
 damaging the posterior lens surface [ fig . 5].9,10 while using the curved or conventional vitrector , the surgeon 
 holds the endoilluminator while the assistant depresses the 
 sclera for view of the anterior vitreous .
this makes the surgery 
 assistant - dependent , time - consuming , and limits the dynamic 
 viewing of the vitreous base with the endoilluminator .
the 20-g curved illuminated vitrector addresses the 
 problems of illumination of the peripheral vitreous and safety 
 of the crystalline lens.11 however , it requires a larger sclerotomy 
 ( 18-g ) than conventionally used , thereby increasing the risk 
 of sclerotomy - related leakage and vitreous incarceration . 

due to the smaller diameter of the shaft , the 25-g curved 
 illuminated vitrector allows removal of the vitreous from the 
 internal sclerotomy site through a conventional sclerotomy 
 ( 20-g ) while preserving the safety of the posterior lens surface . 
 clinical examination as well as ultrasonographic examination 
 confirmed this in both pseudophakic and phakic patients 
 [ fig- 6a , b ] . an illuminated sleeve ( synergetics , inc .
charles , mo ) 
 that wraps around a straight 25-g vitrector provides the benefit 
 of illuminated 25-g vitrector in a pseudophakic eye
. however , 
 the illuminated sleeve does not conform to the curved 25-g 
 vitrector and can not be used in phakic eyes without risk of 
 lens touch . effective and complete
removal of vitreous from the 
 internal sclerotomy prevents postoperative complications 
 associated with wound healing .
sabti et al . , studied 22 eyes 
 with ultrasound biomicroscopy ( ubm ) of which 11 underwent 
 ppv with complete shaving of the vitreous from the internal 
 sclerotomy site by indentation with a straight conventional 
 vitrector , while 11 eyes in the control group underwent 
 conventional ppv only .
complete vitreous shaving around the 
 sclerotomy site significantly reduced vitreous incarceration.4 
 removal of vitreous from the internal sclerotomy assumes 
 added importance during implantation of intra - vitreal drug 
 delivery systems where large sclerotomies are necessary to 
 accommodate the size of the implant ( 2 to 4 mm ) . in a prospective study utilizing ubm to study the internal 
 sclerotomy site in diabetic patients undergoing vitrectomy , 
 bhende et al . , noted that eyes with postoperative vitreous 
 incarceration developed fibrovascular proliferation six months 
 after surgery.3 this is a known high - risk factor for recurrent vitreous 
 hemorrhage after ppv in diabetics
we have successfully employed this instrument in 100 
 complicated vitreoretinal procedures , of which 41 were phakic 
 eyes .
no lens - related complications occurred , though novice 
 surgeons may experience a learning curve with the new device . 
 in summary ,
the 25-g curved illuminated cutter combines the 
 advantage of a self - illuminated vitrectomy probe and custom 
 curved design that avoids crystalline lens touch .
in addition , 
 its usage through a standard 20-g sclerotomy in facilitating 
 complete removal of vitreous from the internal sclerotomy 
 prevents sclerotomy - related complications .
 incarceration of vitreous in sclerotomy sites during pars plana 
 vitrectomy can lead to wound - related complications similar 
 to vitreous incarceration in cataract surgery . 
 we describe an 
 illuminated curved 25-gauge vitrectomy probe for removing 
 vitreous from sclerotomy sites . 
 polyester tubing is used to 
 secure a fiber optic endoilluminator ( 0.5 mm ) with the curved 
 25-gauge vitrector ( 0.5 mm ) . 
 the resultant illuminated curved 
 vitrector ( 20 g ) has a diameter of 1.0 mm . 
 it facilitates complete 
 removal of vitreous around the internal sclerotomies under direct 
 visualization in both phakic and pseudophakic eyes . the same 
 
 was confirmed with ultrasound biomicroscopy of the sclerotomy 
 sites . 
 curved vitrector reduces postoperative complications 
 related to incarcerated vitreous in phakic and pseudophakic eyes 
 and other sclerotomy - related wound complications . 
Design
Technique
Discussion