One-year outcomes of 27-gauge versus 25-gauge pars plana vitrectomy for uncomplicated rhegmatogenous retinal detachment repair

Giancarlo Sborgia,Francesco Boscia,Luigi Sborgia,Maria Oliva Grassi,Samuele Gigliola,Alessandra Sborgia,Giovanni Alessio,Alfredo Niro,Mario R Romano

doi:10.1186/s40942-019-0164-0

Abstract

Background27-gauge (27G) and 25-gauge (25G) transconjunctival sutureless vitrectomy (TSV) were considered equal about safety, effectiveness and vitrectomy time for the treatment of rhegmatogenous retinal detachment (RRD), although larger and long-term comparative studies are needed to confirm previous knowledge. Furthermore, a combined comparison of time duration of surgery and vitreous removal was never performed. Our purpose was to compare the safety and efficacy of 27G versus 25G TSV for the treatment of uncomplicated RRD over a 1-year follow-up.MethodsA 12-months single-center prospective, randomized, interventional study of 92 consecutive patients was performed. 46 patients underwent 27G TSV (Group 1) and 46 underwent 25G TSV (Group 2). Primary outcomes were primary and final reattachment rate, and final functional success (visual acuity ≥ 20/200, 1 LogMar). Secondary outcomes were the surgical and vitrectomy time. Complications were recorded.ResultsAll functional and morphologic data at baseline and at all follow-up time points up to 12 months after surgery were available for only 88 patients. Four patients in Group 1 dropped out of the study after surgery. There was no significant difference in baseline characteristics between the two groups. Primary and final reattachment rates were 90.5% and 100% in Group 1, and 95.6% and 100% in Group 2, respectively (p > .05, p > .05, respectively). Visual acuity improved from 1.5 ± 1.09 LogMar to 0.38 ± 0.55 LogMar in Group 1 (p < .001) and 1.2 ± 0.9 LogMar to 0.49 ± 0.53 LogMar in Group 2 (p < .001), without significant difference between the groups (p > .05). The surgical time was 73.2 ± 11.3 min with 27G TSV and 64.4 ± 9.5 min with 25G TSV (p = .0001). The vitrectomy time was 19.9 ± 3.8 min with 27G TSV and 20.8 ± 3.8 min with 25G TSV (p > .05). One single case of choroidal detachment occurred.ConclusionsReattachment rates, functional success and vitrectomy time were comparable between 27G and 25G TSV for RRD. Surgical time was significantly longer using 27G vitrectomy.

Highlights

Since the introduction of pars plana vitrectomy in early 1970 by Machamer et al [1], as alternative to the scleral buckling surgery to treat rhegmatogenous retinal detachment (RRD), the innovation trend has been moving in the direction of smaller instrument calibers
We found that the 27G transconjunctival sutureless vitrectomy (TSV) provided anatomical and functional results comparable to those obtained using the 25G TSV, as previous papers reported [14, 15, 17]
Our results showed that 27G TSV was as effective as 25G TSV in reattaching the retina after initial surgery and improving visual acuity

Summary

Introduction

Since the introduction of pars plana vitrectomy in early 1970 by Machamer et al [1], as alternative to the scleral buckling surgery to treat rhegmatogenous retinal detachment (RRD), the innovation trend has been moving in the direction of smaller instrument calibers. About this surgical technique, Chen et al [2] proposed a sutureless approach to decrease surgical trauma and postoperative inflammation. Innovations like more powerful light sources, rigid materials for small gauge instruments and more efficient vitrectomy machines with better fluidics and controls, allowed the progression to the 27-gauge (27G) vitrectomy system [6,7,8].

Methods

Results

Discussion

Conclusion