title: Temporal approach for small-gauge pars plana vitrectomy combined with anterior segment surgery.
abstract: OBJECTIVE
  To describe our preliminary experience with temporal small-gauge pars plana vitrectomy (PPV) techniques used to treat anterior and posterior segment pathology.
  
  
  METHODS
  A retrospective consecutive case review of patients who underwent temporal PPV was performed. Patients underwent combined temporal small-gauge PPV and anterior segment intervention. Pre- and postoperative visual acuity, intraocular pressure, surgical indications, intraoperative techniques, postoperative course, and a survey to determine how the change in position affected surgery were examined.
  
  
  RESULTS
  Temporal PPV was performed on 23 eyes with various posterior segment indications and anterior segment pathologies including cataract, pupillary membrane, endophthalmitis, superior filtering blebs, and anterior vitreous membranes. In 20 eyes, 23-gauge instruments were used, and in 3 eyes, 25-gauge instruments were used. Mean postoperative follow-up duration was 7.6 ± 5.0 months (range, 3-22 months). Surgical objectives were achieved in all cases, and no complications occurred in any study eye. Preoperative logarithm of the minimum angle of resolution mean visual acuity was 1.89 ± 0.76 and improved significantly on postoperative Week 1 (1.45 ± 0.81, P = 0.0003), Month 1 (1.13 ± 0.86, P = 0.0001), and at final follow-up (0.88 ± 0.79, P = 0.0001). There was no significant difference in preoperative and postoperative intraocular pressures. Surgeon surveys indicated significant advantages with a temporal approach for each anterior segment indication, no significant differences in performing the basic surgical steps of PPV, and relative ease of adopting this technique.
  
  
  CONCLUSIONS
  Performing PPV from the temporal position seems to be advantageous in cases combining posterior and anterior segment surgery such as cataract extraction, pupillary membrane dissection, preservation of superior conjunctival blebs, and trimanual vitrectomy.
authors.affiliation: Vitreoretinal Service, Department of Ophthalmology and Visual Sciences, Carver College of Medicine, University of Iowa, Iowa City, Iowa 52242, USA.
authors.forename: Ryan M
authors.initials: RM
authors.lastname: Tarantola
authors.forename: Jordan M
authors.initials: JM
authors.lastname: Graff
authors.forename: Riz
authors.initials: R
authors.lastname: Somani
authors.forename: Vinit B
authors.initials: VB
authors.lastname: Mahajan
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000869:Anterior Eye Segment / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007429:Intraocular Pressure / Q000502:physiology; D008297:Male; D008866:Microsurgery / Q000379:methods*; D008875:Middle Aged; D057972:Posterior Eye Segment / Q000601:surgery*; D011187:Posture; D012189:Retrospective Studies; D014792:Visual Acuity / Q000502:physiology; D014821:Vitrectomy / Q000379:methods*; D055815:Young Adult