Abstract
Purpose To compare the anatomical and visual results and complications of 27-gauge versus 25-gauge transconjunctival sutureless vitrectomy for the management of primary rhegmatogenous retinal detachment. Methods A prospective, propensity score-matched 6-month study was performed. All patients underwent either 27-gauge or 25-gauge vitrectomy as the first surgical intervention and were followed up over a 6-month period, in order to evaluate anatomical success, change in best-corrected visual acuity (BCVA), and intraoperative and postoperative complications including intraocular pressure dysregulation. Results Propensity score matching resulted in two groups of 37 eyes each. All eyes completed a six-month follow-up. Baseline demographic and preoperative ocular characteristics showed no statistically significant difference between the two cohorts. The single operation success rate was 33/37 (89%) for 27-gauge cases and 34/37 (92%) for 25-gauge cases (p=0.7). The final anatomical success rate was 100% for each of the two cohorts. Mean BCVA change at the 6-month postoperative follow-up visit was −0.67 logMAR in the 27-gauge group and −0.71 logMAR in the 25-gauge group (p=0.9). Two patients in the 25-gauge group experienced transient hypotony after surgery. Conclusion No significant difference between 27-gauge and 25-gauge transconjunctival sutureless vitrectomy for the repair of primary rhegmatogenous retinal detachment was recorded in terms of reattachment rate, BCVA, intraoperative and postoperative complications.
Highlights
Rhegmatogenous retinal detachment (RRD) is defined as the separation of the neurosensory retina from the retinal pigment epithelium layer secondary to the presence of retinal breaks, allowing the accumulation of fluid in the subretinal space.Over the past decades, the management of RRD has been revolutionized
Subject Characteristics. e comprehensive pool of patients used to create the propensity score matching consisted of 114 eyes (41 in the 27-gauge group and 73 in the 25-gauge group)
Mean best-corrected visual acuity (BCVA) change at the 6-month postoperative follow-up visit was −0.67 logarithm of the minimum angle of resolution (logMAR) in the 27-gauge group and −0.71 logMAR in the 25-gauge group (p 0.9) (Table 2)
Summary
The management of RRD has been revolutionized. Rhegmatogenous retinal detachment has changed from an untreatable condition leading to permanent vision loss to a repairable event after which visual improvement is very likely. A range of surgical techniques have been employed over the years to manage this sightthreatening pathology, including pneumatic retinopexy, scleral buckling, and pars plana vitrectomy (PPV) [1, 2]. Pars plana vitrectomy is nowadays the most commonly used procedure to repair primary RRD [3,4,5]. E main force driving PPV technical advancement is making a successful procedure less invasive, safer, with quicker recovery, and possibly improved outcomes. Smaller sutureless sclerotomy wounds result in less postoperative inflammation, improved patient comfort, and faster recovery
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