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Indian J OphthalmolIndian J OphthalmolIJOIndian Journal of Ophthalmology0301-47381998-3689Medknow Publications & Media Pvt Ltd India 30038160IJO-66-114310.4103/ijo.IJO_1098_18CommentaryCommentary: Evolution of Vitrectomy as Day Care Procedure Badami Kalpana Nagaraj Professor & Head VitreoRetina, Minto Regional Institute of Ophthalmology, Bangalore Medical College & Research Institute, Bengaluru, Karnataka, India
Correspondence to: Dr. Kalpana Nagaraj Badami, Professor & Head VitreoRetina, Minto Regional Institute of Ophthalmology, Bangalore Medical College & Research Institute, Bengaluru, Karnataka, India. E-mail: badamikal@gmail.com8 2018 66 8 1143 1143 Copyright: © 2018 Indian Journal of Ophthalmology2018This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.Feasibility and safety of vitrectomy under topical anesthesia in an office-based setting
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Journey of vitrectomy started with Robert Machemer in 1971 who introduced vitrectomy with single port VISC (Vacuum, infusion, suction, and cutting). Subsequently, infusion, illumination, and cutter were separated by O Malley and Heinz who developed the first three port 20-G (0.9 mm) vitrectomy system in 1974. Size of the Machemer vitrectomy port was 17 G (1.42 mm). However, vitrectomy in pediatric age groups was a concern, and hence, the port size was further reduced to 25 G (0.57 mm) in 2002. With introduction of minimum invasive vitrectomy surgeries (MIVS) 23 G, 25 G, and 27 G, vitrectomy became sutureless, minimized inflammation, and reduced surgical time with good visual recovery.[123]

Then came the idea of minimizing trauma due to regional anesthesia and its dreaded complications.[4]27-G trocar cannula produces very minimal pain under topical anesthesia with and without sedation where surgical time was reduced by 10–20 minutes. In cases such as endophthalmitis, vitreous hemorrhage, vitreous floaters, epiretinal membrane removal, and macular hole, 27 G and topical anesthesia[34] have been tried successfully. TrojanHorse anesthesia,[5] a novel idea of combining topical anesthesia with intracameral anesthesia for better patient comfort is preferred.

Then came the evolution in vitrectomy machines where sturdy equipments were replaced with lighter and compact machines. Innovation in cutters, electrical, and pneumatic cutters with high cut rate was possible even with this mobile, lighter, OPD-based vitrectomy machines. Hence, the idea of performing vitrectomies as office-based procedures under topical anesthesia evolved. Patients were comfortable and also psychologically the fear factor was reduced as it is done in minor operating theatre (OT). Results were good and there were no perioperative complications.

In developing countries like India where cost effectiveness is a concern, vitrectomies as office-based procedures under topical anesthesia should be highly beneficial. This results in reduction of OT time, minimizing cost and also complications but absolutely good visual recovery. Thus, vitrectomy could be a day care procedure in the near future and authors have described it well.
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1 McClintock M  Rezaei K   Recent advances in vitreoretinal surgery. In: Review of Ophthalmology 2015 Last accessed on 2018 Jul 16 Available at: https://www.reviewofophthalmology.com/CMSDocuments/2015/1/rp0115i.pdf  
2 Mohamed S  Claes C  Tsang CW   Review of small gauge vitrectomy, progress and innovations J Ophthalmol 2017 2017 6285869 
3 Warrier SK  Jain R  Gilhotra JS  Newland HS   Sutureless vitrectomy Indian J Ophthalmol 2008 56 453 8 18974514 
4 Theocharis I  Alexandridou A   Sutureless 25G and 23G Vitrectomy Under Topical Anaesthesia Invest Ophthalmol Vis Sci 2006 47 4657 
5 Gupta SK  Kumar A  Sharma A   Trojan Horse anaesthesia, a novel method of anaesthesia for pars plana vitrectomy Oman J Ophthalmol 2018 11 119 23 29930444