27-gauge vitrectomy for posterior segment eye disease: experience at a tertiary care center in Kashmir, India

Abstract

Background: The aim of this work was to study the clinical outcomes, operative time, and complications of 27-gauge (27G) microincision vitrectomy surgery in posterior segment eye disease (PSED). Material and methods: This prospective observational study was conducted at a tertiary care hospital in Kashmir, India. 27G transconjunctival sutureless vitrectomy was performed on 101 eyes of 101 patients with PSED. Results: Of 101 patients, pars plana vitrectomy was indicated for retinal detachment (RD) (n = 36, 35.7%), vitreous hemorrhage (n = 35, 34.7%), epiretinal membrane (ERM)/vitreomacular traction (VMT) (n = 16, 15.9%), macular hole (n = 7, 6.9%), endophthalmitis (n = 4, 3.9%) and intraocular lens drop (n = 3, 2.9%). We observed significant improvement in mean logMAR visual acuity for all indications (p < 0.05 each). Tamponade agents used were fluid (n = 51, 50.5%), silicone oil (n = 30, 29.7%), SF6 gas (n = 15, 14.85%), C3F8 gas (n = 3, 2.97%) and air (n = 2, 1.98%). The intraocular pressure (IOP) increased significantly in cases where silicone oil and SF6 gas were used as tamponade agents (p < 0.05 each). Mean IOP initially increased on the first postoperative day followed by a gradual decline. Overall, the mean operating time was 37.08 minutes and duration of vitreous removal 22.41 minutes. Intraoperative complications included suprachoroidal hemorrhage (n = 1, 0.99%) and inadvertent retinal breaks (n = 1, 0.99%). Postoperative complications included transient hypotony (n = 2, 1.98%), transient ocular hypertension (n = 12, 11.88%), postoperative vitreous hemorrhage (n = 3, 2.97%), recurrent RD (n = 1, 0.99%) and emulsification of silicone oil (n = 3, 2.97%). Conclusions: The 27G system was safe and effective for treating a broad spectrum of PSED. Minimal complications and good visual outcomes warrant a wider adoption of this technique.