Vitreous Surgery:  Incisions and Instruments Get Smaller

Dr. Gregg Kokame performed the first 27 gauge surgery in Hawaii using new technology being developed by Alcon Laboratories in October of 2014.  This was successfully utilized to treat a patient with macular hole (a hole in the central vision part of the retina).  New instruments built specifically for 27 gauge allowed development of a good edge of the scar tissue for peeling of the epiretinal membranes.  This patient had successful closure of the macular hole with improved vision following this 27 gauge surgery.

Dr. Yusuke Oshima from Japan has been the pioneer in 27 gauge surgery, being the first to publish on this technique (Oshima Y, Wakabayashi T, Sato T, Ohji M, Tano Y. A 27-gauge instrument system for transconjunctival sutureless microincision vitrectomy surgery. Ophthalmology. 2010;117:93-102).  Dr. Oshima previously visited Dr. Kokame at Retina Consultants of Hawaii’s Pali Momi office.   Dr. Kokame noted that Dr. Oshima has helped many companies develop the technology necessary to go even smaller with 27 gauge surgery.  “He has told me for years about the benefits of this surgery, and it is very exciting to finally be able to see the results of his work in my own hands.  I think that this technology is very promising.”

20 gauge vitrectomy has been utilized for decades, but recently smaller gauge surgery has become the standard of care utilizing 23 gauge and 25 gauge cannulas for surgery.  27 gauge vitrectomy took some time to develop because technology had to be developed to make the instruments that small and to still function well for the vitreoretinal surgeon.

Dr. Yusuke Oshima , who was the first to publish on 27 gauge vitrectomy, recently retired from his academic position at Osaka University School of Medicine (see picture at left), and now has a thriving private practice.  At his retirement party from the Osaka University, Dr. Oshima (pictured front row far right) is enjoying a celebration with friends from Asia and throughout the world.  Far left is Dr. Fumi Gomi from Japan, a leader in research in polypoidal choroidal vasculopathy (PCV).  In back row pictured  from left to right  are Dr. Timothy Lai from Hong Kong (leader of the PCV course at the American Academy of Ophthalmology with Drs. Kokame and Gomi), Dr. Wai-Ching Lam (retina fellowship director at Toronto, Canada), Dr. Gregg Kokame, Dr. Kourous Rezeai (Director of RETINAWS surgical video education series and FORMULA RETINA Eyetube educational series from Illinois Retina Associates in Chicago), and Dr. Lihteh Wu from Costa Rica.

Macular Hole Pre–27 Gauge Surgery - Retina Consultants of Hawaii

Macular Hole Pre–27 Gauge Surgery

successful closure of macular hole after surgery - Retina Consultants of Hawaii

Successful Closure of Macular Hole Post-Surgery.

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