Constellation vision system

All surgeries were performed by two surgeons (F.O., Y.S.), using standard pars plana vitrectomy with 25 gauge probes (Alcon Constellation vision system) under sub-Tenon local anaesthesia. When a clinically significant cataract was observed, it was simultaneously operated. After inducing posterior vitreous detachment and performing core vitrectomy, we injected 0.2 ml of 0.025% brilliant blue G solution gently over the macula for 15 seconds and washed it out with an irrigation solution. Internal limiting membrane (ILM) peeling and fluid/air exchange were performed in all cases. For the next 1–3 days, the patients were instructed to maintain a face-down position^{8 (link)}.

All surgeries were performed by experienced vitreoretinal specialists. After retrobulbar block using a 4 ml mixture of 0.75% bupivacaine and 2% lidocaine in a 1 : 1 ratio, a standard three-port 23-gauge, or 25-gauge vitrectomy with a wide-angle, noncontact viewing system (Resight®; Carl Zeiss Meditec AG, Jena, Germany) was performed using the constellation vision system (Alcon Laboratories Inc., Fort Worth, TX, USA). For phakic eyes, combined surgery involving phacoemulsification and intraocular lens implantation was performed using the same machine before vitrectomy. During vitrectomy, thick vitreous blood around the vitreous cutting head and optical fiber was initially removed. Subsequently, the anterior and posterior vitreous cavities were removed. If necessary, triamcinolone acetonide was injected to mark the residual vitreous cortex. Using assisted scleral indentation, clear and meticulous shaving of the vitreous base was performed using a wide-angle viewing system. Next, the organized vitreoretinal bands as well as proliferative and neovascular membranes were carefully separated and resected. Hemostasis was achieved by raising the IOP or using endodiathermy. Laser photocoagulation was performed for ischemic areas or holes. At the end of surgery, a balanced salt solution, air, or silicone oil was used to fill the vitreous cavity, as appropriate.

On the basis of the surgeon’s judgment, each patient underwent PPV or SB. PPV involved a 25-gauge transconjunctival microincision and was performed using the Constellation Vision System (Alcon Laboratories, Inc., Fort Worth, TX, USA). The vitreous traction around the retinal breaks was released and the SRF was drained from a posterior drainage retinotomy. Then, fluid-20% sulfur hexafluoride gas exchange and endolaser photocoagulation of the retinal breaks and intentional retinal hole were performed. The epiretinal membrane or internal limiting membrane were not peeled. Patients over 50 years old also underwent simultaneous cataract extraction with posterior chamber intraocular lens implantation^{19 (link)}.When SB was performed, chorioretinal adhesions were created with cryopexy around the retinal breaks. A silicone explant was used to close the peripheral retinal breaks, and external drainage of SRF was performed when necessary. No patients were administered intravitreal injections of gas.

This is a retrospective, interventional study, evaluating consecutive cases that underwent SIO removal after primary 23G vitrectomy for complex retinal detachments. All cases were operated by the same surgeon using local anesthesia. Alcon CONSTELLATION® Vision System was used at both primary vitrectomy and later on to actively remove the silicone oil. Oxane 5700 silicone oil was used for endotamponade in all cases.
The anatomical result was the main followed parameter. Intra and postoperative complications and also intraocular pressure changes were evaluated. Cases were followed-up for at least 12 months.

For vitrectomy, total vitrectomy was performed using the 25-gauge (Constellation^® vision system, Alcon^® Laboratories, Inc.) and then was followed by internal subretinal fluid drainage through fluid-air exchange and laser photocoagulation applied around retinal tears. Fluid-gas exchange (C₃F₈ or SF₆) was performed on all eyes. If there was clinically significant lens opacity preoperatively, phacoemulsification and intraocular lens implantation were performed. All surgeries were performed by only one vitreoretinal surgeon (YHL).