Comparison between 20-, 23-, and 25-G transconjunctival sutureless vitrectomy in the surgical treatment of idiopathic macular hole and idiopathic epiretinal membrane

Abstract

Aim The aim of the present study was to compare 20, 23, and 25-G transconjunctival sutureless vitrectomy (TSV) systems in the management of idiopathic macular hole and idiopathic epiretinal membrane (EMM) as regards the operative time and postoperative complications such as hypotony (as shown by intraocular pressure Patients and methods This prospective, comparative, randomized clinical study was carried out on 60 consecutive patients undergoing TSV at a single center and by the same surgeon. Included patients were with preoperative diagnoses of idiopathic macular hole (group A) and idiopathic EMM (group B). Ten patients of each group were randomly allocated to 25-, 23-, or 20-G TSV subgroups using a table of random numbers. Three-port pars plana vitrectomy with internal limiting membrane peeling in group A with gas tamponade and EMM peeling in group B was carried out. Results In group A, the mean duration of surgery in the 20-G TSV subgroup was 43.7 ± 1.89 min compared with 42.5 ± 2.01 min in the 23-G subgroup and 43.5 ± 1.84 min in the 25-G subgroup. There was no statistically significant difference between the three subgroups. In group B, there was no statistically significant difference between the three subgroups, with a mean time of surgery of 35.8 ± 1.81 min in the 20-G subgroup versus a mean time of 37.9 ± 2.33 and 37.3 ± 1.98 min in the 23-G and the 25-G subgroups, respectively. In group A, the intraocular pressure was within the normal range in all follow-up periods in the three subgroups and no reported cases of hypotony either in the early or late follow-up periods. In group B, there was a statistically significant difference only in the first follow-up period between the three subgroups, as two cases of hypotony in the 20-G subgroup and two cases in the 25-G subgroup were reported, all of which resolved without sequelae. There were no cases of postoperative endophthalmitis in any case of either group A or group B. There were no cases of postoperative retinal detachment in any case of either group A or group B in all follow-up periods. Conclusion The current study indicated no increased risk of postoperative complications such as hypotony, endophthalmitis, or retinal detachment during sutureless vitrectomy.