20-gauge Group Research Articles

Pars plana vitrectomy for disturbing primary vitreous floaters: clinical outcome and patient satisfaction

Primary vitreous floaters can be highly bothersome in some patients. In the case of persistently bothersome floaters, pars plana vitrectomy may be the most effective treatment. The aim of this study is to evaluate the incidence of complications, and patient satisfaction, after pars plana vitrectomy for disabling primary vitreous opacities. We included a total of 110 eyes that underwent pars plana vitrectomy between February 1998 and August 2010. Fifty-seven eyes (51.8%) underwent 20-gauge vitrectomy, whereas 53 eyes (48.2%) underwent 23-gauge vitrectomy. In a retrospective manner, we assessed intraoperative and postoperative complications. There was a considerable range of time between surgery and questionnaire (range: 4-136 months). Patient satisfaction was assessed by a questionnaire based on a modified NEI VFQ-25 questionnaire. A retinal detachment occurred in 10.9% of cases, and the incidence did not differ significantly between the 20-gauge and 23-gauge vitrectomy groups. In 4.5% of the eyes, a retinal detachment developed within the first 3 months, and 6.4% occurred later in the postoperative period. Cystoid macular edema occurred in 5.5%, and an epiretinal membrane was seen postoperatively in 3.6% of cases. Development of glaucoma requiring glaucoma surgery, a macular hole, and postoperative scotoma, each occurred in 0.9% of cases. No cases of endophthalmitis occurred. Eighty-five percent of patients were satisfied or very satisfied with the results of the vitrectomy. Eighty-four percent of all patients were completely cured from their troublesome vitreous floaters, and an additional 9.3% of patients were less troubled by vitreous floaters. Ten patients (9.3%) were dissatisfied, and six of these patients (5.6%) had a serious complication that resulted in permanent visual loss. Pars plana vitrectomy is an effective approach to treat primary vitreous floaters, resulting in a high rate of patient satisfaction. Postoperative complications may be more frequent than previously reported, so patients should be well-informed about the complication rate before reaching informed consent about this surgical intervention. Additional preventive measures should be considered to reduce this complication rate.

Intraoperative Retinal Break Formation in 23-/25-Gauge Vitrectomy versus 20-Gauge Vitrectomy

Background: This study was undertaken to examine the possible effect of microcannula-guided entry sites on the rate of intraoperative retinal break formation. Methods: In this historical cohort study, all patients having undergone vitrectomy with epiretinal or internal limiting membrane peeling performed by one surgeon between January 2005 and March 2009 were included. All procedures with microcannula-guided entry sites (23- and 25-gauge vitrectomy) were compared to procedures without the use of microcannulas (20-gauge vitrectomy). Results: A total of 221 eyes with a follow-up of at least 30 days were analyzed. The total incidence of intraoperative retinal break formation was 25.2% (n = 28/111) for the 20-gauge group and 12.7% (n = 14/110) for the 23-/25-gauge group, resulting in an odds ratio of 2.313 (95% confidence interval 1.142–4.685) of an increased rate in the 20-gauge group. Conclusion: This study demonstrates that intraoperative retinal breaks during vitrectomy are reduced in the microcannula-guided techniques compared to 20-gauge vitrectomy. This effect may be attributed to the protection of the vitreous base during surgery. Further prospective studies are warranted.

Posterior capsule opacification following 20- and 23-gauge phacovitrectomy (posterior capsule opacification following phacovitrectomy)

To compare the development of posterior capsule opacification (PCO) for idiopathic epi-retinal membrane cases between 20- and 23-gauge phacovitrectomy. Cataract surgery of phacoemulsification with the SA60AT implantation and 20- or 23-gauge vitrectomy was performed for 20 patients in both groups. Cataract surgery alone was performed for 50 patients as the control. The PCO density values were measured using Scheimpflug video photography at 1 week, 1, 3, 6, 12, 18, and 24 months after surgery. The number of eyes that required Nd:YAG laser capsulotomy was also examined. The mean PCO value in the 20-gauge phacovitrectomy group increased significantly with time (P<0.001), whereas those in the 23-gauge phacovitrectomy group and the cataract surgery group did not show any significant change. Furthermore, the PCO value in the 20-gauge phacovitrectomy group was significantly greater than that in the 23-gauge phacovitrectomy group at 6, 12, 18 (P<0.05), and 24 months (P<0.01) after surgery. The PCO value in the 23-gauge phacovitrectomy group was significantly greater than that in the cataract surgery group 24 months after surgery (P<0.05). The rate of capsulotomy in the 20-gauge phacovitrectomy group was significantly higher than that in the cataract surgery group (P=0.007), whereas there was no significant difference between the 23-gauge phacovitrectomy group and the cataract surgery group. PCO rate in eyes with the 23-gauge phacovitrectomy was lower than in those with the 20-gauge phacovitrectomy, and PCO rate even in the 23-gauge phacovitrectomy was higher than in those with cataract surgery.

INCIDENCE OF RETINAL BREAKS IN EYES UNDERGOING 23-GAUGE OR 20-GAUGE VITRECTOMY WITH INDUCTION OF POSTERIOR VITREOUS DETACHMENT

To compare the incidence rates of retinal breaks in eyes in which posterior vitreous detachment was induced during 23-gauge and 20-gauge vitrectomies to treat macular holes or preretinal membranes. We retrospectively reviewed 122 eyes of 115 patients with a macular hole or preretinal membrane who underwent induction of posterior vitreous detachment during 23-gauge vitrectomy (23-gauge group) and 61 eyes of 58 consecutive patients with the disorders who underwent induction of posterior vitreous detachment during 20-gauge vitrectomy performed by 1 surgeon. No difference was found in the incidence rates of intraoperative retinal breaks between the 23-gauge (16% [20/122]) and 20-gauge (16% [10/61]) groups. A postoperative rhegmatogenous retinal detachment developed in 2 (2%) eyes in the 23-gauge group, whereas no eyes in the 20-gauge group had postoperative retinal breaks or rhegmatogenous retinal detachment. The incidence rates of retinal breaks in eyes with a macular hole and preretinal membrane did not differ significantly. Posterior vitreous detachment induced during vitrectomy frequently results in intraoperative retinal breaks, the incidence of which may be independent of the gauge of the vitreous instruments. Surgeons should be alert to the development of retinal breaks.

Alterations in the Corneal Topography after Pars Plana Vitrectomy with the Standard System of 20-gauge and the 25-gauge Transconjunctival Sutureless Vitrectomy

Background: To determine the alterations in the corneal topography after pars planavitrectomy with the system of 20- and 25-gauge. Methods: A total of 29 patients with vitreous hemorrhage. The first group (17 patients) had to undergo a pars planavitrectomy with the 20-gauge system, whereas the second (12 patients) had the pars planavitrectomy with the 25-gauge system. The corneal topography was analyzed in the pre-operation, in the first, third, and sixth months in the post-operation. Results: the group which underwent the standartvitrectomy registered a statistically significant difference in the keratometric difference (dK) in the first month compared to the pre-operation (p < 0,000), first month with the third month (p < 0,020), first month and sixth month (p < 0,008). In the 25-gauge system group significant statistical alterations did not occur. Conclusion: astigmatism occurs in the first month post vitrectomy standard. The 25-gauge systemis notinducedastigmatism.

Comparison of Efficacy and Safety between Transconjunctival 23-Gauge and Conventional 20-Gauge Vitrectomy Systems in Macular Surgery

PurposeTo compare the efficacy and safety of 23-gauge transconjunctival vitrectomy with the conventional 20-gauge method in idiopathic epiretinal membrane and macular hole surgery.MethodsSixty-one consecutive patients undergoing vitrectomy for idiopathic epiretinal membrane and macular hole were recruited to either 20- or 23-gauge vitrectomy groups and prospectively evaluated. Surgical success rates, operating time, surgery-related complications, long-term visual outcomes, and postoperative ocular surface problems are compared in the two groups.ResultsThere were 31 eyes in the 20-gauge group and 33 eyes in the 23-gauge group. The macular hole closure rate after the first surgery was 83% and 90.9% in the 20-gauge and 23-gauge groups, respectively, with no significant difference between groups (p = 0.59). The success rate for idiopathic epiretinal membranes cases was 100% in both groups. There was no statistically significant difference between overall surgical times (p = 0.90). None of the patients in either group experienced postoperative complications of severe postoperative hypotony, vitreous hemorrhage or endophthalmitis, except one eye in the 20-gauge group, which was found to have retinal detachment. In both groups, statistically significant improvement in visual acuity was achieved 1-month postoperatively (p = 0.002) and thereafter at all postoperative visits (p < 0.05). The mean ocular surface scores were significantly lower in the 23-gauge group at all postoperative visits compared with the 20-gauge group scores (p = 0.001).ConclusionsTransconjunctival 23-gauge vitrectomy appears to be as effective and safe as conventional 20-gauge vitrectomy in idiopathic epiretinal membrane and macular hole surgeries.

Twenty five-gauge sutureless vitrectomy versus 20-gauge vitrectomy in epiretinal membrane surgery

To compare visual outcomes, intraoperative and postoperative complications of 25-gauge transconjunctival sutureless vitrectomy (25-G TSV) versus conventional 20-gauge vitrectomy in epiretinal membrane (ERM) surgery. A retrospective comparative study was conducted on 200 eyes with idiopathic ERM who underwent either primary 20-gauge vitrectomy (n=95) or 25-G TSV (n=105) with 6 months follow up. The following parameters were collected and compared: age, gender, best corrected visual acuity (BCVA), intraocular pressure (IOP), postoperative anterior chamber inflammation, intraoperative and postoperative complications. Twenty-five gauge group achieved a significantly better vision at the 1(st) postoperative month (p=0.008) and a significantly higher incidence of visual improvement 6 months postoperatively (p=0.04) than 20-gauge group. Intraocular pressure was significantly higher at the 1(st), 3(rd) and 6(th) postoperative months compared with baseline in the 20-G group. However, in the 25-gauge group IOP remained near to the baseline at the same period. Twenty five-gauge group achieved a significantly lower anterior chamber inflammation and a lower incidence of postoperative cystoid macular edema (CME) (p=0.01), hyphema (p=0.000) and after cataract (p=0.000) than 20-gauge group. The 25-gauge sutureless vitrectomy achieves rapid and higher visual improvement, less postoperative inflammation and complications than the 20-gauge vitrectomy in ERM surgery.

The incidence and distribution of iatrogenic retinal tears in 20-gauge and 23-gauge vitrectomy

The development of 23-gauge vitrectomy surgery has many benefits including a reduction in surgical time and faster postoperative rehabilitation; however, some have suggested that the complication rate is higher. To assess this we compared the incidence and distribution of iatrogenic retinal tears in 20- and 23-gauge surgery. Fifty consecutive 23-gauge and 50 consecutive 20-gauge vitrectomy cases were selected; eyes with a history of previous vitreoretinal surgery were excluded. All surgery was performed by two surgeons (JL and RN). Entry-site breaks (ESB) were defined as any new vitreoretinal abnormality occurring within 1 clock hour of an entry site for which treatment with cryotherapy was deemed necessary. Data were collected by retrospective case note review. Statistical analysis was carried out using Fisher's exact and χ(2)-tests. ESB occurred in 24% (12/50) of cases in the 20-gauge group compared with 8% (4/50) in the 23-gauge group (P = 0.03); 88% (14/16) occurred superiorly on the same side as the surgeons' dominant hand. Iatrogenic breaks recorded elsewhere indicated an increased incidence in the 20-gauge group (9/50 compared with 6/50 in 23-gauge) but this did not achieve significance; the most common position was at 6 o'clock. 23-Gauge vitrectomy is associated with significantly fewer ESB when compared with conventional 20-gauge vitrectomy. The incidence of other iatrogenic breaks did not appear to be significantly different between the two groups.

INCIDENCE OF IATROGENIC PERIPHERAL RETINAL BREAKS IN 23-GAUGE VITRECTOMY FOR MACULAR DISEASES

To assess the incidence of iatrogenic peripheral retinal breaks in 23-gauge vitrectomy for macular diseases and to compare it with 20-gauge vitrectomy. Retrospective, comparative, interventional case series. We compared the incidence of iatrogenic peripheral retinal breaks in 176 eyes undergoing 23-gauge vitrectomy between January 2007 and November 2009 (23-gauge group) and 153 eyes undergoing 20-gauge vitrectomy between January 2004 and June 2006 (20-gauge group) for either idiopathic macular holes or idiopathic epiretinal membranes. All surgeries were performed by one surgeon at a single hospital. Main outcome measure was the incidence rate of iatrogenic peripheral retinal breaks discovered intraoperatively and postoperatively. Iatrogenic peripheral retinal breaks occurred in 1 eye in the 23-gauge group and in 11 eyes in the 20-gauge group during surgery. Additional iatrogenic retinal breaks were found in 1 eye in the 23-gauge group and in 2 eyes in the 20-gauge group within 1 month after surgery. The overall incidence of iatrogenic peripheral retinal breaks was 1.1% (2 of 176) in the 23-gauge group and 8.5% (13 of 153) in the 20-gauge group. The difference was statistically significant (P = 0.0023). The incidence of iatrogenic peripheral retinal breaks during vitrectomy for macular diseases is significantly lower in 23-gauge vitrectomy than in 20-gauge vitrectomy.

COMPARATIVE STUDY BETWEEN A STANDARD 25-GAUGE VITRECTOMY SYSTEM AND A NEW ULTRAHIGH-SPEED 25-GAUGE SYSTEM WITH DUTY CYCLE CONTROL IN THE TREATMENT OF VARIOUS VITREORETINAL DISEASES

To compare a standard 25-gauge vitrectomy system with a new ultrahigh-speed (UHS) 25-gauge system with duty cycle control for pars plana vitrectomy. In this prospective, controlled clinical trial, 120 patients (divided into 2 groups of 60 patients) underwent a 3-port pars plana vitrectomy for the treatment of epiretinal membranes, macular holes, retinal detachment, and complications of diabetic retinopathy. Evaluations were performed preoperatively, intraoperatively, on the first 3 postoperative days, and at 1 week, 1 month, and 3 months. Main outcome measures were vitrectomy time, induction of posterior vitreous detachment, and intra- and postoperative complications. Vitrectomy time included retinal manipulation, but did not include wound opening and closure. The duration of surgery was significantly different between the groups. Patients in the new UHS 25-gauge group had a significantly shorter duration of vitrectomy time (P < 0.0001). Mean overall vitrectomy time was 1,583.7 ± 875.4 seconds (26 minutes) in the standard 25-gauge group and 1,106.3 ± 575.9 seconds (18 minutes) in the UHS 25-gauge group. Twenty-nine patients (48.3%) in the standard group and 27 patients (45.0%) in the UHS group experienced induction of posterior vitreous detachment. Thirteen patients (21.7%) in the standard 25-gauge group and 1 patient (1.7%) in the new UHS group had intraoperative iatrogenic retinal breaks. The new-generation UHS 25-gauge system may provide a new paradigm of high-flow, smaller-diameter instrumentation, thus increasing the efficiency of the small-gauge technique and the safety of the surgery.

Surgical Outcomes of 23- and 20-Gauge Vitrectomies for Rhegmatogenous Retinal Detachment Associated With Posterior Vitreous Detachment

To compare the outcomes of 23- and 20-gauge vitrectomies 1 year after primary repair of rhegmatogenous retinal detachments (RRDs) associated with a posterior vitreous detachment (PVD). One hundred seventy-five consecutive eyes were reviewed that had undergone 23- or 20-gauge vitrectomy for RRDs associated with PVD. Retinal reattachment during the year after the first vitrectomy occurred in 88 (91%) of 97 eyes in the 23-gauge group and 70 (90%) of 78 eyes in the 20-gauge group. All eyes in both groups achieved anatomic success after another procedure. The surgical time in the 23-gauge group was significantly (P = .03) shorter than in the 20-gauge group. No significant difference was found between the preoperative and postoperative visual acuities in both groups. Twenty-three-gauge vitrectomy can obtain anatomic and visual acuity results similar to those obtained with 20-gauge vitrectomy after primary repair of RRDs and may be a surgical option for treating the disorder.

23- and 20-Gauge Vitrectomy with Air Tamponade with Combined Phacoemulsification for Idiopathic Macular Hole: A Single-Surgeon Study

To compare the results of 23- and 20-gauge vitrectomies combined with phacoemulsification and aspiration and intraocular lens implantation (phacoemulsification surgery) 1 year after repair of idiopathic macular holes. Retrospective, consecutive, comparative case series. The medical charts of 100 consecutive eyes were reviewed that had undergone either 23- or 20-gauge vitrectomy combined with phacoemulsification surgery to treat an idiopathic macular hole performed by 1 surgeon. The rate of improvement of the logarithm of the minimal angle of resolution visual acuity (VA) was calculated using the formula: (postoperative value - preoperative value) × 100/(1-year postoperative value - preoperative value). The macular holes closed successfully after the primary vitrectomy in all eyes in both groups. Although the VAs did not differ significantly before surgery or 1 year after surgery between the 2 groups, the VA improvement was significantly greater 1 and 3 months after surgery (P = .02, for both) in the 23-gauge group compared with the 20-gauge group. The induced corneal astigmatism levels 1 week and 1 and 3 months after surgery were significantly lower (P = .01, P = .01, and P = .03, respectively) and the surgical time was significantly shorter (P = .01) in the 23-gauge group than in the 20-gauge group. No apparent complications developed in either group. Since 23-gauge vitrectomy combined with phacoemulsification surgery is advantageous because the VA improved rapidly after treating the macular holes with an acceptable safety profile, idiopathic macular holes are a good indication for 23-gauge vitrectomy combined with phacoemulsification surgery.

DOES 23-GAUGE SUTURELESS VITRECTOMY MODIFY THE RISK OF POSTOPERATIVE RETINAL DETACHMENT AFTER MACULAR SURGERY?

To compare the cumulative risk of retinal detachment (RD) after macular surgery with 23-gauge sutureless vitrectomy and with 20-gauge vitrectomy. A single-center retrospective comparative study was conducted, comparing eyes operated for epiretinal membrane, macular hole, vitreomacular traction, and internal limiting membrane peeling. The 23-gauge group included 349 eyes operated consecutively between June 2007 and December 2008. The 20-gauge group included 346 eyes operated between October 2003 and September 2007. After a 6-month follow-up, the cumulative probability of RD was 1.1% in the 23-gauge group and 3.5% in the 20-gauge group (P = 0.04). With a median follow-up of 14 months (range, 6-30 months) in the 23-gauge group and 30 months (range, 6-72 months) in the 20-gauge group, the cumulative probability of RD was, respectively, 1.1% and 4.9% (P = 0.04; log-rank test). Overall, RD was observed in 7 of 96 cases after macular hole surgery (7.3%), in 11 of 478 cases after epiretinal membrane surgery (2.3%), and in 3 of 70 cases after vitreomacular traction surgery (4.3%) (P = 0.14; log-rank test). After a short-term follow-up, a lower rate of postoperative RD was observed in the 23-gauge group. Sutureless 23-gauge vitrectomy appears safe when considering the risk of postoperative RD. Prospective and long-term studies are still needed to confirm these results.

RETROSPECTIVE COMPARISON OF 25-GAUGE TRANSCONJUNCTIVAL SUTURELESS VITRECTOMY TO 20-GAUGE VITRECTOMY FOR THE REPAIR OF PSEUDOPHAKIC PRIMARY INFERIOR RHEGMATOGENOUS RETINAL DETACHMENT

To compare anatomical and functional outcomes of 25-gauge transconjunctival sutureless pars plana vitrectomy (PPV) to standard 20-gauge 3-port PPV for the treatment of pseudophakic rhegmatogenous retinal detachments with inferior breaks. Retrospective review of 78 consecutive eyes from 78 patients undergoing primary vitrectomy with a minimum of 3-month follow-up. Thirty patients underwent 25-gauge PPV and 48 patients underwent 20-gauge PPV from May 1993 to July 2008. Variables and outcome measures included patient demographics, retinal reattachment, best-corrected visual acuity, macular status, postoperative intraocular pressures, and surgical complications. Preoperative characteristics were similar in both groups. Single operation success rate was 25/30 (83.3%) for 25-gauge cases and 43/48 (89.6%) for 20-gauge cases (P = 0.50). Transient hypotony occurred in 6/30 25-gauge eyes and 1/48 20-gauge eyes (P = 0.01), whereas hypertension occurred in 10/30 25-gauge cases and 15/48 20-gauge cases. All but 2 eyes were attached at final follow-up (97%). At final follow-up, mean best-corrected visual acuity was 0.28 and 0.32 for the 25-gauge and 20-gauge groups (P = 0.74). Outcomes of 20-gauge versus 25-gauge PPV for the management of pseudophakic inferior rhegmatogenous retinal detachments were not significantly different, with hypotony being the most significant postoperative complication in the 25-gauge group as compared with the 20-gauge group.

COMPARISON OF CLINICAL OUTCOMES BETWEEN 23-GAUGE AND 20-GAUGE VITRECTOMY IN PATIENTS WITH PROLIFERATIVE DIABETIC RETINOPATHY

The purpose of this study was to compare the clinical outcomes and complications between 23-gauge transconjunctival sutureless vitrectomy and 20-gauge vitrectomy in patients with proliferative diabetic retinopathy. This is a retrospective comparative study comprising 101 eyes from 90 consecutive patients who had diabetic vitrectomy due to nonclearing vitreous hemorrhage. Thirty-five eyes underwent 23-gauge transconjunctival sutureless vitrectomy, and 66 eyes underwent 20-gauge vitrectomy. Main outcome measures were best-corrected visual acuity, intraocular pressure, and incidence of intraoperative and postoperative complications with at least 6 months of follow-up. Best-corrected visual acuity of both groups at postoperative months 1, 3, and 6 significantly improved from the preoperative best-corrected visual acuity (P < 0.0001, respectively). There was no difference for best-corrected visual acuity between the 2 groups at each follow-up period (P > 0.05, respectively). Intraocular pressure of the 23-gauge group at postoperative Day 1 and Week 1 was less than the preoperative intraocular pressure (P < 0.0001 and 0.017). Operating time of the 23-gauge group was shorter than the 20-gauge group (P < 0.0001). There was no difference in the incidence of intraoperative and postoperative complications except transient postoperative hypotony, which occurred in 8 eyes (22.9%) from the 23-gauge group (P < 0.0001). Twenty three-gauge transconjunctival sutureless vitrectomy appears to be as effective for proliferative diabetic retinopathy as 20-gauge vitrectomy.

Subconjunctival reflux and need for paracentesis after intravitreal injection of 0.1 ml bevacizumab: comparison between 27-gauge and 30-gauge needle

Intravitreal injections may lead to a significant elevation of the intraocular pressure (IOP). A paracentesis may become necessary for acute reduction of the IOP in certain cases. The purpose of this study was to determine the frequency of paracentesis performed and the grade of reflux under the conjunctiva after injection of 0.1 ml bevacizumab (1.25 mg), depending on the thickness of the needles used. A retrospective review was undertaken of the surgery reports of 234 consecutive intravitreal bevacizumab injections in 145 eyes of 144 patients within 14 months. In particular, the frequency of paracentesis, the thickness of the needles used (27-gauge versus 30-gauge), the lens status, and a semi-quantitative reflux grade were analysed. A paracentesis was performed in 78 cases (33%) for acute reduction of the IOP. In the 27-gauge group the frequency was 26% (25 of 96), and in the 30-gauge group 38% (53 of 138) (p = 0.05, independent estimating equation (IEE)). The medians of the semi-quantitative assessment of the reflux grade under the conjunctiva were 2.0 in the 27-gauge group (corresponding to a mild reflux) and 1.0 in the 30-gauge group (corresponding to a minimal reflux, p < 0.001, IEE). When using a 30-gauge needle for intravitreal injections, the reflux under the conjunctiva was less than with a 27-gauge needle. However, the use of a 30-gauge needle appeared to be associated with a higher frequency of paracentesis.

Comparison of 20- and 25-Gauge Vitrectomy for Primary Repair of Rhegmatogenous Retinal Detachment

To evaluate the outcome of 25-gauge transconjunctival pars plana vitrectomy and compare it with that of 20-gauge pars plana vitrectomy for primary repair of rhegmatogenous retinal detachment. A retrospective study of a consecutive series of 166 eyes of 164 patients who underwent pars plana vitrectomy for primary rhegmatogenous retinal detachment was performed. One hundred nineteen eyes underwent 25-gauge vitrectomy and 47 eyes underwent 20-gauge vitrectomy. The anatomic success rates after the initial surgery in the 25-gauge vitrectomy and 20-gauge vitrectomy groups were 93.3% and 91.5%, respectively. The median visual acuity improved significantly from 20/80 preoperatively to 20/30 postoperatively in the 25-gauge group, and from 20/90 to 20/30 in the 20-gauge group. Good anatomic and functional results were achieved with 25-gauge vitrectomy and the outcomes compared favorably with those of 20-gauge vitrectomy for the treatment of rhegmatogenous retinal detachment.

Bacterial Contamination of the Vitreous Cavity Associated with Transconjunctival 25-Gauge Microincision Vitrectomy Surgery

To evaluate differences in the bacterial contamination rates of the vitreous cavity between patients undergoing transconjunctival 25-gauge microincision vitrectomy surgery (MIVS) and conventional 20-gauge pars plana vitrectomy (PPV). Prospective, comparative, consecutive, interventional case series. Eighty-one eyes of 81 patients who underwent primary vitrectomy and completed perioperative sample collection. Patients were randomly assigned to 25-gauge MIVS or 20-gauge PPV. Conjunctival swabs were obtained from each patient before and after preoperative administration of topical 0.5% moxifloxacin. Vitreous samples were collected at the beginning and end of surgery. All 4 consecutive specimens from each eye were cultured using direct culturing techniques under aerobic and anaerobic conditions. The primary outcome measure was the incidence of bacterial contamination of the vitreous cavity at the start and end of vitrectomy. The secondary measures were the incidence of bacterial contamination of the ocular surface and the disinfection rate with preoperative moxifloxacin. Of the 81 eyes (40 eyes in the 25-gauge MIVS group; 41 eyes in the 20-gauge PPV group), the incidences of positive bacterial isolation at the 4 time points of sample collection were 77.5%, 62.3%, 22.5%, and 0% in the former group and 82.9%, 63.4%, 2.4%, and 0% in the latter group. Although the rate of bacterial contamination of the ocular surface significantly (P<0.001) decreased after preoperative moxifloxacin administration in both groups, transconjunctival 25-gauge MIVS had a significantly (P = 0.007) higher incidence of vitreous contamination at the beginning of surgery compared with conventional 20-gauge PPV. The multivariate model showed that 25-gauge MIVS (odds ratio, 11.27; P = 0.027; 95% confidence interval, 1.31-96.79) was the factor prognostic of vitreous contamination at the beginning of surgery. Propionibacterium acnes was identified most often in the vitreous samples (80% of cases), which was consistent with the commensal bacteria isolated from the ocular surface. The higher incidence of bacterial contamination of the vitreous cavity at the beginning of 25-gauge MIVS suggests the increasing risk of direct inoculation of ocular surface flora into the vitreous cavity through the transconjunctival trocar-cannula system compared with conventional 20-gauge PPV. However, vitreous cavity contamination can be eliminated during vitrectomy in most cases. Proprietary or commercial disclosure may be found after the references.

TWENTY-THREE-GAUGE AND 20-GAUGE VITRECTOMY IN EPIRETINAL MEMBRANE SURGERY

The purpose of this study was to investigate the safety profile of the 23-gauge sutureless vitrectomy system in the treatment of epiretinal membranes compared with standard 20-gauge vitrectomy. A retrospective case comparison of 20-gauge and 23-gauge vitrectomy performed in 167 and 64 eyes, respectively, by the same surgeon. Intraoperative and postoperative complications, duration of surgery, and postoperative visual acuity results were evaluated. Postoperative hypotony occurred significantly more often in the 23-gauge group [9.4% (n = 6) vs. 0% (n = 0), P < 0.001]. With the 23-gauge system, the incidence of retinal detachment was 1.6% (n = 1), vitreous hemorrhage was 0%, and endophthalmitis was 1.6% (n = 1). Patients with 20-gauge vitrectomy developed retinal detachments in 1.8% (n = 3), vitreous hemorrhages in 1.2% (n = 2), and endophthalmitis in 2.4% (n = 4). The mean overall duration of surgery was significantly shorter in the 23-gauge procedures with 23.1 +/- 6.5 minutes compared with 34.5 +/- 9.1 minutes in the 20-gauge procedures (P < 0.05). At postoperative Day 2, patients with 23-gauge vitrectomy regained preoperative mean best-corrected visual acuity of 20/60. Patients who had 20-gauge vitrectomy experienced a statistically significant decrease of visual acuity from 20/80 to 20/100 (P < 0.05). Twenty-three-gauge vitrectomy in epiretinal membrane surgery is comparable with 20-gauge vitrectomy and is a safe method with a low complication rate. However, the incidence of postoperative hypotony is more frequent using the 23-gauge system.

Transconjunctival Sutureless Vitrectomy for the Treatment of Vitreoretinal Complications in Patients With Diabetes Mellitus

To compare the safety and effectiveness of 25-gauge transconjunctival sutureless vitrectomy (TSV) with conventional 20-gauge pars plana vitrectomy (PPV) for the treatment of vitreoretinal complications in patients with diabetic retinopathy. Forty-five eyes of 44 consecutive patients with diabetes mellitus who had undergone 25-gauge TSV for the treatment of vitreous hemorrhage, traction retinal detachment, or diabetic macular edema and 45 control patients with diabetes mellitus who had undergone conventional 20-gauge PPV were studied. The mean duration of surgery in the 25-gauge TSV group was statistically significantly shorter than that in the 20-gauge PPV group. The mean visual acuity at both 1 week and 1 month after surgery was statistically significantly better in the 25-gauge TSV group than in the 20-gauge PPV group. Complications in the 25-gauge TSV group were similar to those in the 20-gauge PPV group. A shorter operation time and faster recovery of postoperative visual acuity were the main advantages of using 25-gauge TSV. Despite its limitations, 25-gauge TSV can be safely used for the treatment of vitreoretinal complications in patients with diabetes mellitus.