|LETTER TO THE EDITOR
|Year : 2019 | Volume
| Issue : 1 | Page : 182-183
Response to comment on: Feasibility and safety of vitrectomy under topical anesthesia in an office-based setting
Gloria P Trujillo-Sanchez1, Alejandro Gonzalez-De la Rosa2, Jose Navarro-Partida3, Luis Haro-Morlett1, Juan C Altamirano-Vallejo2, Arturo Santos2
1 Centro de Retina Médica y Quirurgica, S.C., Centro Médico Puerta de Hierro, Zapopan, Jalisco, México
2 Centro de Retina Médica y Quirurgica, S.C., Centro Médico Puerta de Hierro; Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Campus Guadalajara, Zapopan, Jalisco, México
3 Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Campus Guadalajara, Zapopan, Jalisco, México
|Date of Web Publication||21-Dec-2018|
Dr. Arturo Santos
Centro de Retina Médica y Quirúrgica, S.C. Boulevard Puerta de Hierro 5150.202 A, Puerta de Hierro, 44160 Zapopan, Jalisco
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Trujillo-Sanchez GP, Rosa AG, Navarro-Partida J, Haro-Morlett L, Altamirano-Vallejo JC, Santos A. Response to comment on: Feasibility and safety of vitrectomy under topical anesthesia in an office-based setting. Indian J Ophthalmol 2019;67:182-3
|How to cite this URL:|
Trujillo-Sanchez GP, Rosa AG, Navarro-Partida J, Haro-Morlett L, Altamirano-Vallejo JC, Santos A. Response to comment on: Feasibility and safety of vitrectomy under topical anesthesia in an office-based setting. Indian J Ophthalmol [serial online] 2019 [cited 2020 Nov 28];67:182-3. Available from: https://www.ijo.in/text.asp?2019/67/1/182/248129
We appreciate the authors for their keen interest in our article. We cautiously analyzed their observations and concerns about 27-gauge vitrectomy procedures in an office-based setting and we have the following comments. First, we consider that office-based vitrectomy under topical anesthesia is not only safe for vitreous floaters but these procedures could be excellent tools for prompt, cost-effective evaluation in macular interventions; however, just in a selected group of patients. We ponder, like other authors, that this technique must be performed by an experienced surgeon and in a well-informed and cooperative patient to guarantee adequate surgical outcomes and good safety profile. As the author mentioned, macular procedures represent only a small fraction of the total cases in our series. However, surgical objectives were achieved in all our cases. We recognize that further studies with larger samples are required to establish a conclusion about the safety profile for macular surgeries.
In relation to discomfort of patients during the procedure, it is important to emphasize that pain was reported only during trocar insertion, even though sclerotomies were made in one-step (no beveled) in all cases. Like other authors have mentioned, the most painful moment or discomfort in vitreoretinal procedures is experienced during initial trocar insertion.,,, However, the complete surgical experience was not unpleasant, and up to 82.35% of the patients requested the same procedure in the fellow eye.
On the other hand, it is important to clarify that the mean surgical time reported was measured from the insertion procedure until removal of the cannulas. The reduced time registered for our procedures was directly related to case selection. In total, 88.23% of the operated eyes already had vitreous liquefaction and separation, nevertheless, in those cases without this condition, it was easily induced using the vitreous cutter and active aspiration. In this case series, the reported surgical time was enough to effectively achieve all surgical goals, as no adverse event related to the surgical procedure has been reported at the present time, when all patients have accomplished at least 17-month follow-up period.
Finally, we highly recommend that office-based vitrectomy under topical anesthesia should be consider only in carefully selected cases. Clinical characteristics as well as surgeon's experience are critical variables to contemplate before performing this procedure.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Kumawat D, Sahay P, Sundar D, Chawla R. Comment on: Feasibility and safety of vitrectomy under topical anesthesia in an office-based setting. Indian J Ophthalmol 2018;67:181-2.
Trujillo-Sanchez GP, Gonzalez-De La Rosa A, Navarro-Partida J, Haro-Morlett L, Altamirano-Vallejo JC, Santos A. Feasibility and safety of vitrectomy under topical anesthesia in an office-based setting. Indian J Ophthalmol 2018;66:1136-40.
] [Full text]
Mohan A, Venkatesh R. Commentary: Office-based vitrectomy using topical anesthesia in an Indian setting. Indian J Ophthalmol 2018;66:1141-2.
] [Full text]
Mahajan D, Sain S, Azad S, Arora T, Azad R. Comparison of topical anesthesia and peribulbar anesthesia for 23-gauge vitrectomy without sedation. Retina 2013;33:1400-6.
Bahcecioglu H, Unal M, Artunay O, Rasier R, Sarici A. Posterior vitrectomy under topical anesthesia. Can J Ophthalmol 2007;42:272-7.
Celiker H, Karabas L, Sahin O. A comparison of topical or retrobulbar anesthesia for 23-gauge posterior vitrectomy. J Ophthalmol 2014;2014:237028.
Tang S, Lai P, Lai M, Zou Y, Li J, Li S. Topical anesthesia in transconjunctival sutureless 25-gauge vitrectomy for macular-based disorders. Ophthalmologica 2007;221:65-8.