20-gauge Group Research Articles

Small-Gauge Vitrectomy for Macular Surgery Using a Systematic Approach to Wound Closure: 27-Gauge vs 25-Gauge.

Purpose: To evaluate the effectiveness of and to compare vitrectomy performed with 25-gauge or 27-gauge instrumentation for macular surgery by assessing the surgical duration, wound closure, and complication rate using a systematic approach to wound closure. Methods: In this retrospective chart review, 125 25-gauge and 125 27-gauge consecutive small-gauge vitrectomy surgeries for epiretinal membrane, macular hole, vitreomacular adhesion, or a combination were analyzed during and immediately after surgery. Wound closure was performed using a systematic protocol. Results: Baseline characteristics were not statistically different between the 2 groups. The surgical duration was similar with 25-gauge vitrectomy and 27-gauge vitrectomy (P = .07). Although spontaneous wound closure was common in both groups, it was more common in the 27-gauge group (P = .22). Intraoperative and postoperative complications were uncommon in both groups. Conclusions: Findings show that 27-gauge vitrectomy is a safe, effective alternative to the more commonly used 25-gauge vitrectomy for macular surgery. Less manipulation was required to achieve wound closure with 27-gauge vitrectomy using a standardized wound-closure protocol. Smaller 27-gauge vitrectomy did not increase surgical time or complications over 25-gauge vitrectomy for macular surgery.

20-Gauge vs. 23-Gauge Vitrectomy, in Terms of Surgically Induced Astigmatism

OBJECTIVES To compare the post-operative (post-op) surgically induced mean astigmatism in patients undergoing 20-gauge- and 23-gauge vitrectomy. METHODOLOGY Sixty patients were enrolled. Relevant information was recorded in a Performa for each patient. Patients were randomly grouped into A (20-gauge) and B (23-gauge) groups. Astigmatism was recorded by a single technician using the same keratometer for all patients. A single surgeon operated on all patients. Post-operatively, all patients were re-examined after 1 week and 6 weeks, and their surgically induced astigmatism was recorded. RESULTSOf 60 patients, 58.6% were males, and 41.4% were females, with a mean age of 53.77 ± 9.63 years. The post-operative astigmatism difference between the two vitrectomy procedures was investigated. In the 20-gauge group, with 30 patients, the mean post-operative astigmatism difference was 2.21 D (±0.66 SD), with a standard error mean of 0.12. In the 23-gauge group, with 30 patients, the mean post-operative astigmatism difference was 0.74 D (±0.44 SD), with a standard error mean of 0.08. The degrees of freedom (df) were 58, and the standard error of the difference was 0.145. The t-value was calculated at 10.1504, and the p-value was found to be 0.001, indicating a significant difference. CONCLUSION The observation that the 20-gauge group displayed a notably higher mean difference in astigmatism than the 23-gauge group suggests a potential association between the choice of vitrectomy procedure and the extent of astigmatism alteration in post-operative outcomes.

A Prospective Randomized Study Comparing 27-Gauge Vitrectomy to 23-Gauge Vitrectomy for Epiretinal Membranes and Full-Thickness Macular Holes.

To compare the surgical and clinical outcomes of 27-gauge vitrectomy and 23-gauge vitrectomy. We conducted a single-center, prospective, randomized study. Fifty-three patients affected by vitreoretinal interface disorders (epiretinal membranes and macular holes) were randomly scheduled to undergo 27-gauge (28 patients) or 23-gauge (25 patients) pars plana vitrectomy. The presence of any potential factor of increased baseline inflammation or eye anatomy influencing the surgery was criteria for exclusion. The time of surgery, postoperative intraocular pressure (IOP), state of sclerotomy wounds, rate of complications, postoperative pain, and indicators of inflammation were studied. We also introduced a new parameter to compare intraocular inflammation after surgery, given by the change in the number of intraretinal hyperreflective foci (HRF). The 27-gauge vitrectomy was 1.28 min longer than 23-gauge vitrectomy (P < 0.05). The day after surgery, the mean IOP value was significantly higher in the 27-gauge group (16.12 mmHg versus 13.04 mmHg in the 23-gauge group,P < 0.05), but this difference disappeared in successive follow-ups and the sclerotomy wounds closed after 2 weeks in the both groups. The rate of postoperative hypotony did not significantly differ in the two groups (10.71% in the 27-gauge group and 8% in the 23-gauge group the day after the surgery,P = 0.94). Less postoperative eye redness was seen in 27-gauge eyes (value 1 on the scale) compared to 23-gauge (value 2 on the scale) (P < 0.05), but there was no significant difference in intraocular inflammation (cells, Tyndall, and number of HRF,P > 0.05 for all). The 27-gauge vitrectomy may have better outcomes in terms of IOP maintenance and cause less redness after the surgery but with a slightly prolonged surgery time and no other differences under other parameters (inflammation, rate of complications, postoperative pain, visual gain, and closure of the sclerotomy wounds).

Endophthalmitis after pars plana vitrectomy with reused single-use devices: a 13-year retrospective study

BackgroundTo describe the incidence, clinical characteristics, and treatment outcomes of endophthalmitis after pars plana vitrectomy (PPV) with recycled single-use devices. The recommended sterilization process as well as safety measures are discussed.MethodsMedical charts of patients who developed endophthalmitis after PPV were retrospectively reviewed and reported in a descriptive manner. Cases undergoing PPV for preexisting endophthalmitis or open globe injury were excluded. Data collection included patient demographics, operative details, ocular findings, microbiological profiles, treatment modalities, and visual outcomes.ResultsOver the past thirteen years, a total of 12,989 pars plana vitrectomy operations were included. In total, 13 eyes of 13 cases (0.10%) experienced endophthalmitis after vitrectomy. These occurred in 3 cases (0.11%) using 20-gauge vitrectomy compared to 8 cases (0.09%) using 23-gauge vitrectomy and 2 cases (0.18%) using 25-gauge vitrectomy. There were no statistically significant differences between the 20-gauge and microincisional vitrectomy surgery (MIVS) group (P = 0.64), and the 23- and 25-gauge approach (P = 0.34). Causative pathogens were positive by culture in 5 cases (45%): 3 g-positive cases, 1 g-negative case, and 1 fungus case.ConclusionsThe rate of endophthalmitis in patients who underwent 23-gauge PPV was comparable to those who underwent 25-gauge PPV. With our standardized protocol for instrument sterilization, endophthalmitis rates in those undergoing PPV using recycled single-use instruments were within the range of previously published results in which vitrectomy tools were disposed of after one use.

Comparison of Characteristics and Clinical Outcomes in 27-Gauge versus 23-Gauge Vitrectomy Surgery.

PurposeTo compare characteristics, clinical outcomes and complication profiles of a cohort of patients undergoing 27-gauge versus 23-gauge vitrectomy surgery at a tertiary medical center in the Middle East.MethodsThis is a retrospective comparative study of indication-matched patients undergoing 27-gauge versus 23-gauge pars plana vitrectomy for a set of predetermined diagnoses. Data including indications for surgery, clinical exams, visual outcomes, and complications were documented and analyzed.ResultsA total of 22 patients who had 27-gauge pars plana vitrectomy were compared with 44 patients who had 23-gauge surgery for matched indications by a single retina surgeon. Mean follow-up was 14 months after surgery. Indications included macular pucker, macular hole, and vitreous hemorrhage. Both the rate of hypotony at postoperative day 1 and the need for sclerotomy stitching at the end of surgery were significantly more frequent in 23-gauge compared to 27-gauge cases (25% in 23-gauge compared to 0% in 27-gauge (p=0.012) and 18% in the 23-gauge compared to 0% in the 27-gauge (p=0.045), respectively). The mean duration of surgery was similar among groups (35 mins in the 27-gauge group versus 39 mins in the 23-gauge group (p=0.116)), and all eyes achieved anatomic success. In the 27-gauge group, best-corrected visual acuity improved from a mean of 20/90 at baseline to a mean of 20/40 at 1 month (p=0.005) and in the 23-gauge group from a mean of 20/95 to 20/50 (p=0.001) with no statistical difference between the groups.ConclusionIn this cohort of patients undergoing vitrectomy at a tertiary eye center, the rate of hypotony and the need for sclerotomy suturing were significantly less in the 27-gauge group versus the 23-gauge group. Surgical outcomes were similar in both study groups. The use of the novel 27-gauge instrument system is useful in selected vitreoretinal diseases and appears comparable to the widely used 23-gauge system.

Abstract No. 523 Biopsy-gauge size, patient, and lesional factors affecting iatrogenic pneumothorax rates for lung biopsies

To determine iatrogenic pneumothorax rates affected by biopsy gauge size, patient and lesional factors for lung biopsies performed at a small university hospital. An analytical search for all lung biopsies performed between 2009-2019 was obtained from a searchable database. Overall, 227 patients were selected. The patient population was composed of 108 males with an average age of 61.8 years. The patients were subdivided into either 18-gauge (with 17-gauge coaxial needle) or 20-gauge (with 19-gauge coaxial needle) biopsies. Then, medical records, imaging, and procedural reports were reviewed to determine outcomes. Of the patient population, 180 subjects underwent 18-gauge biopsies and 47 subjects underwent 20-gauge biopsies. The average number of biopsies obtained for each procedure was 4.0. Overall, 51 patients (22%) had iatrogenic pneumothorax, of which 13 patients (5.7%) underwent chest tube placement. Pneumothoraces were observed in 43 patients (24%) for 18-gauge biopsies and 8 patients (17%) for 20-gauge biopsies (P = 0.315). Intervention was required in 12/43 (28%) patients in the 18-gauge group and 1/8 (12%) patients in the 20-gauge group (P = 0.459). The number of passes made for patients who did and did not develop a pneumothorax was similar in both groups (3.91 vs. 4.07, P = 0.494). Significant factors included lesion average diameter (2.06 cm vs. 3.87 cm, P <0.001) and depth from pleura (2.28 cm vs. 1.58 cm, P = 0.032) in those with and without a pneumothorax, respectively. Gender and age were not significant factors affecting pneumothorax rates. The rate of lung biopsy induced pneumothorax is not significantly different between 18-gauge and 20-gauge biopsies. Smaller lesions and those requiring a longer needle trajectory increased pneumothorax rates.

Incidence and Risk Factors of Iatrogenic Retinal Breaks: 20-Gauge versus 25-Gauge Vitrectomy for Idiopathic Macular Hole Repair.

Purpose We compared the incidences of iatrogenic retinal breaks and postoperative retinal detachment between eyes that underwent 20-gauge vitrectomy and those that underwent 25-gauge vitrectomy for idiopathic macular hole repair. Methods This retrospective nonrandomized consecutive observational case series included 185 eyes of 183 patients (130 eyes of 129 patients and 55 eyes of 54 patients in the 20- and 25-gauge groups, respectively). We assessed the relationship between the incidence of retinal breaks and postoperative retinal detachment and related this to posterior vitreous detachment and lattice degeneration. Results The incidences of iatrogenic retinal breaks were 36.9% and 12.7% in the 20-gauge and 25-gauge groups, respectively. These groups did not differ in their respective frequencies of posterior vitreous detachment (the 20-gauge group: 31.5% and the 25-gauge group: 27.3%) and lattice degeneration (the 20-gauge group: 14.6% and the 25-gauge group: 7.3%). Among eyes without lattice degeneration, the 20-gauge group showed a higher incidence of iatrogenic retinal breaks than the 25-gauge group. However, among the eyes with lattice degeneration, the frequency of retinal breaks did not differ between the two surgery types, and four cases of postoperative retinal detachment were reported in both groups. Conclusions The incidence of retinal breaks related to idiopathic macular hole surgery is higher among patients undergoing 20-gauge vitrectomy than among those undergoing 25-gauge vitrectomy. Posterior vitreous detachment and lattice degeneration are associated with considerably increased incidences of retinal break.

A Propensity-Score Matching Comparison between 27-Gauge and 25-Gauge Vitrectomy Systems for the Repair of Primary Rhegmatogenous Retinal Detachment.

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.

BIMANUAL MICROINCISION VITREOUS SURGERY FOR SEVERE PROLIFERATIVE DIABETIC RETINOPATHY: OUTCOME IN MORE THAN 300 EYES.

To evaluate the visual and anatomical outcomes and safety of bimanual microincision vitreous surgery for severe proliferative diabetic retinopathy. Retrospective review of 315 eyes of 282 patients who underwent 23-gauge or 25-gauge pars plana vitrectomy with bimanual membrane dissection for diabetic tractional detachment from January 2007 to September 2016. Minimum follow-up was 3 months, and the average duration of follow-up was 23 months (range 3-100 months; median 15 months). Outcome measures were best-corrected visual acuity, anatomical success, and postoperative complications. Postoperatively, 84.3% of eyes improved (>2 lines), 10.5% were stable, and 5.4% worsened (>2 lines). Comparing gauges, two-line improvement was seen in 87.4% of 23-gauge eyes compared with 79.7% of 25-gauge eyes (P = 0.029). Mean peak best-corrected visual acuity improved from 20/930 (1.67 ± 0.63) preoperatively to 20/120 (0.78 ± 0.63) postoperatively (P < 0.001). Primary reattachment was achieved in 310 eyes (98.4%) and final reattachment in 312 eyes (99%). Recurrent vitreous hemorrhage was the commonest postoperative complication (18.4%). Lower incidence of recurrent vitreous hemorrhage was seen with 25 gauge (13.5%) compared with 23 gauge (22%, P = 0.038). Epiretinal membrane formation (7.9%), intractable glaucoma (2.5%), and endophthalmitis (0.6%) were some of the other postoperative complications. Sustained visual improvement, anatomical restoration, and low complication rates were obtained in complex situations with bimanual microincision vitreous surgery in a large series. Visual outcomes were poorer in older age group, tractional retinal detachments involving macula, and eyes with extensive membranes and with silicone oil as tamponade. Both 23-gauge and 25-gauge groups were comparable in relation to visual improvement, anatomical success, and intraoperative and postoperative complications.

Twenty-nine-gauge dual-chandelier retroillumination for the non-open-sky continuous curvilinear capsulorhexis in the penetrating keratoplasty triple procedure

We describe a technique for the penetrating keratoplasty (PKP) triple procedure that uses 29-gauge dual-chandelier illumination during creation of a non-open-sky continuous curvilinear capsulorhexis (CCC). The chandeliers are inserted through the pars plana into the vitreous cavity through the bulbar conjunctiva at the 3 o'clock and 9 o'clock positions. We compared this approach with that of a core vitrectomy, in which a single 25-gauge port is inserted into the vitreous cavity transconjunctivally through the upper temporal pars plana. The area of halation around the corneal opacity was significantly smaller in the 29-gauge group than in the 25-gauge group. The reduction in halation improved visibility of the anterior capsule and enabled the surgeon to perform CCC with greater safety. The 29-gauge chandelier system was more suitable than the 25-gauge chandelier system for the non-open-sky CCC component of the PKP triple procedure.

Comparative study of 25- versus 20-gauge pars plana capsulotomy and vitrectomy in pediatric cataract surgery.

To compare 25- and 20-gauge pars plana vitrectomy (PPV) for the management of pediatric cataract. 20 eyes of 15 patients were randomly divided into two groups to undergo pars plana capsulotomy and vitrectomy by either 25-gauge (group A) or 20-gauge (group B) PPV after lens aspiration and IOL implantation. The two groups were compared for total surgical time, time taken in doing pars plana capsulotomy and vitrectomy, and the size of posterior capsulotomy. Post-operative astigmatism was compared at 3months. The mean total surgical time in group A was 49.2±6.7min, while mean total surgical time in group B was 62.5+5.48min (p=0.001). The mean time taken for pars plana capsulotomy and vitrectomy was 4.1±1.19min in group A and 5.0±0.73min (p=0.03) in group B. The mean size of the PCCC in group A was 3.3±0.34mm, while in group B it was 4.0±0.33mm (p=0.001). The mean astigmatism at 3months in group A was 0.65±0.31 diopters, while in group B it was 1.45±0.92 diopters (p=0.019). 25-gauge transconjunctival sutureless PPV can be an attractive alternative to 20-gauge system in the management of pediatric cataracts.

Intravitreal Injections of Bevacizumab: The Impact of Needle Size in Intraocular Pressure and Pain.

ABSTRACTAim To compare the effect of 30-gauge vs 27-gauge needle size on intraocular pressure (IOP) rise and patients’ pain experience after intravitreal injection (IVI) of bevacizumab.Materials and methods Cross-sectional, randomized, double-armed study. Patients were randomized to IVI with 30-gauge or 27-gauge needle. The IOP was measured pre and post IVI. Patients’ pain was graded using the visual analog scale (VAS).Results A total of 54 eyes were included. The IVI caused a significant IOP rise in both groups (p < 0.001). In the 30-gauge group, the mean pre- and postinjection IOP was 16.3 ± 3.6 mm Hg and 24.1 ± 9.0 mm Hg. The corresponding figures in the 27-gauge group were 18.0 ± 2.54 (p = 0.26) and 23.1 ± 7.5 mm Hg (p = 0.66). In the 30-gauge group, the mean VAS pain score was 3.2 ± 2.6 compared to 3.0 ± 2.5 in the 27-gauge group (p = 0.78).Conclusion The IVI caused a significant rise in IOP after the injection, independently of the needle size used. The 27-gauge needle coursed with lower postinjection IOP without prejudice of the patient comfort.Clinical significance The IVI with 27-gauge may be considered for glaucomatous eyes (higher risk eyes), for which IOP spikes are not recommended.How to cite this article Loureiro M, Matos R, Sepulveda P, Meira D. Intravitreal Injections of Bevacizumab: The Impact of Needle Size in Intraocular Pressure and Pain. J Curr Glaucoma Pract 2017;11(2):38-41.

Four‐port bimanual 23‐gauge vitrectomy for diabetic tractional retinal detachment

Four-port bimanual vitrectomy is a surgical technique that facilitates removal of epiretinal membranes in severe proliferative diabetic retinopathy (PDR). As the illumination is held by the assistant through the fourth scleral incision, fibrovascular membranes are removed by bimanual manipulation techniques. The objective of this study was to evaluate the safety and efficacy of four-port bimanual 23-gauge vitrectomy for patients with tractional retinal detachment (TRD) in severe PDR. Retrospective, comparative, consecutive, interventional case series. Sixty-six eyes of 58 consecutive patients who underwent primary vitrectomy for severe diabetic TRD. Thirty-six eyes of 31 cases that were treated with four-port 23-gauge vitrectomy were compared with 30 eyes of 27 cases that were treated with 23-gauge pars plana vitrectomy (PPV). Main outcome measures were best-corrected visual acuity (BCVA), retinal status, intraocular pressure, and incidence of intraoperative and postoperative complications with at least 6months of follow-up. The primary and ultimate anatomic success rates (94.4% versus 93.3%, and 100% in both groups, respectively) and the mean BCVA changes did not differ significantly between groups. The whole surgical time and the membrane removal time were significantly (p<0.001, respectively) shorter in the four-port 23-gauge group than in the 23-gauge group. There was no difference in the incidence of intraoperative and postoperative complications in both groups. Four-port bimanual 23-gauge vitrectomy offers comparable anatomic success and shortens the surgical time compared with conventional 23-gauge PPV in patients with TRD resulting from severe PDR.

To determine block establishment time of supraclavicular brachial plexus block using blunt versus short bevel needle: A prospective randomized trial

Background:Unintentional intraneural injection under ultrasound guidance (USG) with fine caliber needles and lower success rate with large caliber Tuohy needles in supraclavicular brachial plexus block (SCB) have been reported.Materials and Methods:We undertook study to standardize the use of 20-gauge short versus blunt bevel needle for SCB. After approval of Institutional Ethics Committee and written informed consent, patients were randomized using computer-generated random number table to either of the two groups; blunt bevel needle group (n = 30): SCB under USG using 20-gauge Tuohy needle or short bevel needle group (n = 30): SCB under USG using 20-gauge short bevel needle. The primary outcome of the study was time to establishment of sensory and motor block of individual nerves, and secondary outcome was tolerability and any adverse effects.Results:The time to establishment of sensory and motor block in individual nerve territory was similar in both the groups. The complete sensory and motor anesthesia was achieved in 78.3% patients and complete sensory and motor anesthesia after supplementary block was achieved in 86.6% patients. Paresthesias during SCB were recorded in 15 patients. Out of these eight patients were of blunt bevel group and seven patients were of short bevel group. None of the patients experienced any neurological adverse effects.Conclusion:The establishment of sensory and motor blockade of individual nerves was similar to 20-gauge short and blunt bevel needle under ultrasound guide with no neurological adverse events.

Comparison of microbiology and visual outcomes of patients undergoing small-gauge and 20-gauge vitrectomy for endophthalmitis.

BackgroundThe role of pars plana vitrectomy (PPV) for endophthalmitis has evolved over recent decades but the literature is lacking on comparisons between small-gauge and 20-gauge vitrectomy.ObjectiveTo evaluate evolving etiological and microbiological trends in patients undergoing vitrectomy for endophthalmitis and to compare culture-positive rates and visual outcomes between small-gauge (23- and 25-gauge) and 20-gauge instrumentation during vitrectomy for endophthalmitis.MethodsTen-year retrospective comparative case series and prospective laboratory in vitro testing. Tertiary care academic referral center. Patients who underwent PPV for endophthalmitis between 2003 and 2013. Vitreous biopsies were obtained in all cases. The effect of vitrectomy gauge (20-, 23-, and 25-gauge) and vitreous cutting rate (1,500 and 5,000 cuts per minute) on the viability of bacterial culture was evaluated in an in vitro prospective laboratory investigation.Main outcome measuresComparison of etiology, microbiology culture-positive rates, and visual outcomes between small-gauge and 20-gauge instrumentation in patients undergoing PPV for infectious endophthalmitis.ResultsA total of 61 cases of vitrectomy for endophthalmitis were identified over a 10-year period; of these, 34 were treated with small-gauge (23- and 25-gauge) vitrectomy and 27 were treated with 20-gauge vitrectomy. In the small-gauge group, 12 cases (35.3%) yielded culture-positive results versus 20 cases (74.1%) with culture positivity in the 20-gauge cohort (P=0.002). The most common cause of endophthalmitis was cataract surgery and the most frequently identified organism was coagulase-negative Staphylococci in both groups. There was no significant difference in mean postoperative visual acuities between groups (P=0.33). Etiological trends indicate an increase in endophthalmitis due to intravitreal injection in the small-gauge group (n=9) compared to the 20-gauge group (n=3) (P=0.001). In vitro laboratory testing revealed no significant difference in rates of culture growth for different vitrectomy gauge sizes or vitreous cutting speeds.Conclusion and relevanceSmall-gauge vitrectomy for endophthalmitis yields final visual outcomes comparable to 20-gauge instrumentation. A significant difference in culture-positive rates was observed between small-gauge and 20-gauge instrumentation for vitrectomy in endophthalmitis; however, laboratory testing indicates this is not related to either vitreous gauge size or cutter speed. Intravitreal injections are emerging as a common etiology of vitrectomy for endophthalmitis.

Surgical induced astigmatism correlated with corneal pachymetry and intraocular pressure: transconjunctival sutureless 23-gauge versus 20-gauge sutured vitrectomy in diabetes mellitus.

To determine the difference of surgical induced astigmatism between conventional 20-gauge sutured vitrectomy and 23-gauge transconjunctival sutureless vitrectomy, and the influence of corneal pachymetry and intraocular pressure (IOP) on surgical induced astigmatism in diabetic patients. This retrospective, consecutive case series consisted of 40 eyes of 38 diabetic subjects who underwent either 20-gauge or 23-gauge vitrectomy. The corneal curvature and thickness were measured with Scheimpflug imaging before surgery and 1wk; 1, 3mo after surgery. We compared the surgical induced astigmatism (SIA) on the true net power in 23-gauge group with that in 20-gauge group. We determined the correlation between corneal thickness change ratio, IOP and SIA measured by Pentacam. The mean SIAs were 1.082±0.085 D (mean±SEM), 0.689±0.070 D and 0.459±0.063 D at postoperative 1wk; 1, 3mo respectively in diabetic subjects. The vitrectomy induced astigmatisms were declined significantly with time (F 2,36=33.629, P=0.000) postoperatively. The 23-gauge surgery group induced significantly less astigmatism than 20-gauge surgery group (F -1,37=11.046, P=0.020). Corneal thickness in diabetes elevated after surgery (F 3,78=10.532, P=0.000). The linear regression analysis at postoperatively 1wk went as: SIA=-4.519+4.931 change ratio (Port3) +0.026 IOP (R(2)=0.46, P=0.000), whereas the rate of corneal thickness change and IOP showed no correlation with the change of astigmatism at postoperatively 1 and 3mo. There are significant serial changes in both 20-gauge and 23-gauge group in diabetic subjects. 23-gauge induce less astigmatism than 20-gauge and become stable more rapidly than 20-gauge. The elevation of corneal thickness and IOP was associated with increased astigmatim at the early postoperative stage both in 23-gauge and 20-gauge surgery group.

The 23G and 20G vitrectomy for patients with diabetic retinopathy

Objective To compare the clinical outcomes and complications between 23-gauge and 20-gauge transconjunctival sutureless vitrectomy for patients with proliferative diabetic retinopathy.Methods 64 eyes of 52 consecutive patients who underwent diabetic vitrectomy were enrolled in this retrospectively comparative study.40 eyes of 32 patients underwent 23G microincision vitrectomy(23G group).24 eyes of 20 patients underwent 20G vitrectomy(20G group).The follow-up time was 6 months.The best corrected visual acuity (BCVA),intraocular pressure (IOP),and incidence of intraoperative and postoperative complications were compared.Results BCVA of both groups at postoperative 1,3 and 6 months improved significantly compared with the preoperative BCVA (x2 =20.32,22.56,18.23,P ＜ 0.01).The I OP of the 23-gauge group at postoperative day 1 was lower than the preoperative IOP (t =2.75,P ＜ 0.01).The Operating time of 23-gauge group was shorter than the 20-gauge group (t =2.71,P ＜ 0.01).There was no significant difference in the incidence of intraoperative and postoperative complications except transient postoperative hypotony,which occurred in 9 eyes(22.5％) of the 23-gauge group (x2 =4.56,P =0.03).Conclusion 23-gauge transconjunctival sutureless vitrectomy appears to be as effective as 20-gauge vitrectomy for proliferative diabetic retinopathy.There is no significant difference between two methods in intraoperative and postoperative complications. Key words: Retinopathy, diabetic, proliferative; Vitrectomy, 23-gauge,20-gauge; Research,comparative

Evaluation of Wound Morphology of Sclerotomy Sites of Sutureless Vitrectomy Using Spectralis Anterior Segment Optical Coherence Tomography.

The aim of the study was to evaluate wound morphology in vivo in eyes undergoing sutureless vitrectomy. This was a prospective consecutive case series. Twenty eyes undergoing sutureless vitrectomy were evaluated using anterior segment optical coherence tomography on days 1, 15, and 30. Ten eyes each belonged to 23-gauge (group A) and 25-gauge (group B). Scans were taken on the incision sites. Group A cases were further divided into group A1 and A2 on the basis of the surgical time of less than 15 minutes' and more than 15 minutes' duration, respectively. On day 1, the mean outer and inner incision diameters in group A were 236.6 and 146 µm, and those for group B were 118.6 and 90 µm. A significant decrease (P < 0.0001) in both the port sizes was observed in both groups' follow-up. Group B showed significant decrease (P < 0.0001) in the port sizes on l follow-up as compared with group A. Group A1 had smaller incision size as compared with group A2 on the first postoperative day, although not statistically significant(P > 0.05). In both groups, the sclerotomy incisions showed good healing at 1-month duration. The 25-gauge sclerotomies showed better healing characteristics of wound morphology as compared with the 23-gauge sclerotomies.

TWENTY-FIVE-GAUGE VITRECTOMY FOR THE REMOVAL OF 5000 CENTISTOKES SILICONE OIL

To compare the safety and efficacy of removing 5000 centistokes silicone oil between 20-gauge and 25-gauge vitrectomy technique. Prospective case series of 34 consecutive patients undergoing 5000 centistokes silicone oil removal using 20-gauge or 25-gauge cannulas. The main outcome measures were the safety and efficacy of silicone oil removal. The safety was evaluated by recording intraoperative and postoperative complication rates, including bleeding, recurrence of retinal detachment, hypotony, choroidal detachment, corneal edema, endophthalmitis, vitreous hemorrhage, conjunctival injection, and subconjunctival hemorrhage. The efficacy was judged by the ability to attain the complete removal of silicone oil and the total surgical time to complete the procedure. Sixteen patients underwent 20-gauge vitrectomy for the removal of 5000 centistokes silicone oil between January 2008 and January 2010, and 18 patients underwent 25-gauge vitrectomy for the removal of 5000 centistokes silicone oil from January 2010 to August 2012. Silicone oil was successfully removed completely in all cases. Using 25-gauge vitrectomy to remove silicone oil was significantly more time efficient with the mean total surgical time of 25 ± 6 minutes compared with 42 ± 10 minutes in 20-gauge vitrectomy group (P < 0.05). There were no differences in the intraoperative or postoperative complication rates between the two groups. None of the patients developed postoperative recurrence of retinal detachment, hypotony, choroidal detachment, corneal edema, endophthalmitis, or vitreous hemorrhage. Twenty-five-gauge silicone oil removal is safe and effective. Surgical time is significantly reduced using sutureless 25-gauge sclerotomies. This may translate to cost reduction by decreasing time spent in the operating room.

Changes in Day 1 Post-Operative Intraocular Pressure Following Sutureless 23-Gauge and Conventional 20-Gauge Pars Plana Vitrectomy

Background/Aims: The benefits associated with transconjunctival sutureless vitrectomy techniques are continuing to be defined. The purpose of this study was to compare the incidence of extreme changes in day 1 intraocular pressure (IOP) following 23-gauge sutureless vitrectomy compared with conventional 20-gauge vitrectomy.Methods: Fifty consecutive 23-gauge and 50 consecutive 20-gauge cases were included; eyes with a history of previous vitreoretinal surgery were excluded. 23-gauge surgery was completed with passive fluid air exchange where no long acting tamponade was indicated. The surgery remained sutureless unless a leak was visible at the end of the procedure. Data were collected by retrospective case note review. Statistical analysis was carried out using Fisher’s exact and chi-square tests.Results: Twenty-two percent (11/50) of 23-gauge vitrectomies required suturing of one or more ports. On the first post-operative day hypotony (IOP<5mmHg) occurred in 1/50 eyes in the 20- and 23-gauge groups. Raised pressure (IOP>21mmHg) occurred in 30% (15/50) of eyes in the 20-gauge group and 8% (4/50) of eyes in the 23-gauge group; IOP>30mmHg only occurred in the 20-gauge group (3/50).Conclusion: Fluid air exchange following 23-gauge vitrectomy is associated with very low risk of day 1 hypotony. This predominantly sutureless technique appears to reduce the incidence and magnitude of early post-operative IOP elevation compared with conventional 20-gauge vitrectomy.