Supplementary Material for: ‘Mini-Gauge’ Pars Plana Vitrectomy: ‘Inside-Out View’ with the GRIN Solid Rod Endoscope

<i>Purpose:</i> To stimulate the discussion about ‘mini-gauge’ pars plana vitrectomy. <i>Methods:</i> Gradient index high-resolution endoscopy to analyze the 23- or 25-gauge access into the vitreous cavity. A total number of 66 pars plana interventions (almost 200 cannulas) were performed and recorded with the gradient index solid rod endoscope as well as through the microscope. <i>Results:</i> Five main ‘inside-out’ observations were made through the endoscope. Some very slight rotating movement of the trocar was required to achieve a safe cannula implantation. Rotating the cannula too much could result in some unwanted side effects. The major amount of vitreous incarceration occurs during the implantation of cannulas. Incarcerated vitreous causes significant anterior-posterior vitreous traction. Intraocular cleaning of the port with the suction cutter releases the anterior-posterior traction without increasing the postoperative rate and degree of hypotony. Side effects like bleeding of the wound are likely to occur due to any sort of manipulation to the outside of the sclerotomy (i.e. cotton tips) other than the essential replacement of the conjunctiva. <i>Discussion:</i> Surgeons who are considering the conversion to mini-gauge pars plana vitrectomy systems may be aided by endoscopic observations.

**研究目的**：旨在围绕“小口径睫状体平坦部玻璃体切割术（mini-gauge pars plana vitrectomy）”展开讨论。
**研究方法**：采用梯度折射率高分辨率内窥镜（gradient index high-resolution endoscopy），对23G或25G入路进入玻璃体腔的过程进行分析。本研究共完成66例睫状体平坦部手术操作（涉及近200根灌注套管），并通过梯度折射率固态杆状内窥镜及手术显微镜对操作过程进行记录。
**研究结果**：通过内窥镜共获得5项主要的“由内向外”观测结果：为实现安全的套管植入，需对套管针（trocar）进行极轻微的旋转操作；套管旋转过度可能引发不良副作用；大部分玻璃体嵌顿发生于套管植入过程中；嵌顿的玻璃体可引发显著的前后向玻璃体牵拉；使用抽吸切割器对套管端口进行眼内清洁，可解除前后向玻璃体牵拉，且不会增加术后低眼压（hypotony）的发生率与严重程度。除必要的结膜复位操作外，任何对巩膜切开术（sclerotomy）切口外侧的操作（如使用棉片擦拭）均可能引发伤口出血等副作用。
**讨论**：本研究的内窥镜观测结果，可为考虑转型采用小口径睫状体平坦部玻璃体切割术系统的外科医师提供参考。