20-gauge Group Research Articles

Comparison of 25- and 23-gauge sutureless microincision vitrectomy surgery in the treatment of various vitreoretinal diseases

To compare the effectiveness and safety of 25- and 23-gauge sutureless microincision vitrectomy surgery (MIVS) in the management of various vitreoretinal diseases. Eighty-five consecutive patients undergoing sutureless vitrectomy during January to April 2008 were randomized to either 25- or 23-gauge MIVS. Data collected prospectively included best-corrected visual acuity (BCVA), operation time, postoperative visual recovery, postoperative anterior segment change, and complications. The most common indications for MIVS were macular hole, macular pucker, vitreous haemorrhage, and diabetic traction retinal detachment. Mean operation times of the 25-gauge (n=38) and 23-gauge groups (n=47) were 33.68 and 34.47 min, respectively (P=0.942). Mean BCVA improved significantly in both the 25- and 23-gauge groups when measured 3-month postoperatively. There was no between-group difference in either the degree or the rate of postoperative visual recovery. Seven patients in the 23-gauge group, compared with three in the 25-gauge group, required suturing of sclerotomy at the end of the surgery. No patients in either group developed postoperative wound leakage or endophthalmitis. Our prospective study suggests that, within the limited indications, both 25- and 23-gauge MIVS are equally effective, with similar safety profiles. Gauge selection thus may be made according to a surgeon's preference and the availability of appropriate instruments.

Blinded Prospective Comparison of the Performance of 22-Gauge and 25-Gauge Needles in Endoscopic Ultrasound-Guided Fine Needle Aspiration of the Pancreas and Peri-pancreatic Lesions

Both 22- and 25-gauge needles are used for endoscopic ultrasound (EUS)-guided fine-needle aspiration (FNA) of lesions, yet limited data exist on whether either offers an advantage over the other in terms of specimen cellularity and quality. The aim of this study was to compare sample quality for 22- and 25-gauge needles in EUS-guided FNA of pancreatic and peri-pancreatic lesions. Between October 2005 and June 2006, 12 patients with pancreatic or peripancreatic lesions underwent EUS-guided FNA with both 22- and 25-gauge Wilson-Cook Echotip needles. All procedures were performed with an Olympus linear echoendoscope by the same endoscopist to eliminate operator-dependent variability. Needle order was selected randomly, and two passes were made with each needle, consisting of ten uniform to-and-fro movements on each pass with 10-ml syringe suction. The specimens were immediately stained and independently reviewed by two cytopathologists, who were blinded to the needle used. Cellularity was graded as 0 to 6, with 6 being most cellular. No statistically significant difference in cellularity was detected between the two needle size groups by cytologist 1 (mean difference, 0.04; 95% confidence interval [CI], -1.22 to 1.30; p = 0.94) or by cytologist 2 (mean difference, 0.2; 95% CI, -1.23 to 1.65; p = 0.76). When the data from both cytologists were combined, no significant difference in cellularity was detected between the two needle sizes (mean difference, 0.125; 95% CI, -1.22 to 1.47; p = 0.84). No significant difference in cellularity was detected between cytologists 1 and 2 (mean difference, 0.17; 95% CI, -0.15 to 0.48; p = 0.27). When the order in which needles were used was compared, no significant difference in cellularity was detected (p = 0.75). Three mechanical failures occurred with 25-gauge needles, but none occurred with 22-gauge needles. The visibility of the needles on EUS did not differ. Cytologic diagnoses were achieved in all cases: seven pancreatic adenocarcinomas, one pancreatic giant cell carcinoma, one pancreatic neuroendocrine tumor, one metastatic non-small cell carcinoma, one metastatic colon carcinoma, and one pancreatitis. There were no procedure-related complications. Both FNA needles provided accurate diagnoses in all patients. There was no significant difference between the 22- and 25-gauge needle groups in the independent interpretation of two cytopathologists with respect to cellular yield and ability to render a diagnosis.

Comparison of 3 Needle Sizes for Trigger Point Injection in Myofascial Pain Syndrome of Upper- and Middle-Trapezius Muscle: A Randomized Controlled Trial

Yoon S-H, Rah UW, Sheen SS, Cho KH. Comparison of 3 needle sizes for trigger point injection in myofascial pain syndrome of upper- and middle-trapezius muscle: a randomized controlled trial. Objectives To investigate (1) the relation between needle diameter and treatment efficacy of myofascial pain syndrome and (2) the relation between needle diameter and pain intensity during injection. Design Randomized controlled trial. Setting University-affiliated tertiary-care hospital. Participants Volunteers (N=77) with myofascial pain syndrome affecting upper- and middle-trapezius muscles with at least 3 months' duration of pain. Intervention Participants were randomly assigned to receive trigger point injections on 1 side of the trapezius with a 21-, 23-, or 25-gauge needle. After a 1-time injection, participants were followed up for 14 days. Participants and the assessor were blinded for group assignment. Main Outcome Measures Treatment efficacy was measured with the visual analog scale (VAS; at pretreatment, and posttreatment on days 1, 4, 7, 14) for neck and upper-back pain, the Neck Disability Index (NDI; at pretreatment, and posttreatment on days 7, 14), and the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36, at pretreatment and posttreatment on days 7, 14) for health-related quality of life. Pain intensity during injection was evaluated immediately after injection with VAS. Results VAS scores for posttreatment on days 4, 7, and 14 decreased significantly compared with pretreatment scores in all groups; NDI scores on days 7 and 14 decreased significantly compared with pretreatment scores in all groups; SF-36 scores on days 7 and 14 decreased significantly compared with pretreatment scores in the 21- and 23-gauge needle groups; and SF-36 score on day 14 showed significant difference between the 21- and 25-gauge needle groups. For pain intensity during injection, VAS scores indicated no significant difference between the 3 groups. Conclusions No difference between the needle types was observed in terms of VAS or NDI, or in terms of pain intensity felt by patients during injection. In terms of SF-36 scores, injections with 21- or 23-gauge needles were found to be more effective. However, a well-controlled investigation is needed to explore the effect of needle thickness on health-related quality of life.

Endophthalmitis after Pars Plana Vitrectomy: A 20- and 25-Gauge Comparison

Recent retrospective analyses have suggested that postoperative endophthalmitis may be more frequent with 25- than 20-gauge pars plana vitrectomy (PPV). Because the infection risk may depend on the suturing status of the sclerotomy, and the perioperative anti-infection protocol, we compared the incidence rate of endophthalmitis after sutureless 25-gauge versus sutured 20-gauge PPV on a large cohort of patients operated with a standardized perioperative anti-infection protocol. Retrospective comparative case series. Consecutive patients who underwent 20- or 25-gauge PPVs at a single center over a multi-year period. We analyzed 3597 consecutive PPVs. Patients with a pre-PPV diagnosis of endophthalmitis, PPVs performed for implantation of drug delivery devices, or 25-gauge PPVs with all sclerotomies sutured closed were excluded. Patients with > or =1 week of follow-up were divided into 2 study groups by sclerotomy status at the end of surgery: the 20-gauge group had 3 sutured 20-gauge sclerotomies, and the 25-gauge group had > or =1 unsutured 25-gauge sclerotomy. Endophthalmitis was defined by clinical criteria independent of microbiological results. The incidence of endophthalmitis was compared between 25- versus 20-gauge groups. Of 3372 PPV surgeries meeting inclusion and exclusion criteria, 1948 and 1424 surgeries were 20- and 25-gauge PPVs, respectively. Average age (+/- standard deviation) of patients was 54.6 (+/- 22.6) and 64.4 (+/- 16.5) years in the 20- and 25-gauge PPV groups, respectively (P<0.0001). Median post-PPV follow-up time was not significantly different between the 2 groups (12.5 vs 13.0 months; P = 0.69). Endophthalmitis was observed in 1 patient (0.07%; 95% confidence interval, 0%-0.21%) from the 25-gauge group and none in the 20-gauge group (P = 0.42; Fisher exact test, 2-tailed). The use of air/gas endotamponade (P<0.0001) and intravitreal triamcinolone (P<0.001) was more common in 25- versus 20-gauge PPV. The incidence of endophthalmitis was low in both groups. We were unable to show a significant difference in the incidence of endophthalmitis between sutureless 25-gauge and sutured 20-gauge PPV, and conclude that a careful perioperative anti-infection protocol may reduce 25-gauge PPV endophthalmitis risk to that of 20-gauge PPV.

Surgically induced astigmatism in combined phacoemulsification and vitrectomy; 23-gauge transconjunctival sutureless vitrectomy versus 20-gauge standard vitrectomy

To study the surgically induced astigmatism (SIA) in combined phacoemulsification with 23-gauge transconjunctival sutureless vitrectomy (TSV) versus combined phacoemulsification with 20-gauge standard vitrectomy. This is a prospective comparative study comprised of 40 eyes from 37 consecutive patients. Twenty eyes (19 patients) underwent combined phacoemulsification and 23-gauge TSV, and 20 eyes (18 patients) underwent combined phacoemulsification and 20-gauge standard vitrectomy. Corneal topography was obtained preoperatively and postoperatively at weeks 1, 4, 8, and 12. Main outcome measurement was SIA consisting of astigmatic amplitude and axis from cross cylinder form calculated by rectangular coordinate method using the Holladay-Cravy-Koch formula. The mean SIA was 1.07 +/- 0.57 diopters (D) in the 23-gauge TSV group and 2.09 +/- 0.81 D in the 20-gauge group at postoperative week 1. SIA of both groups at weeks 4, 8, and 12 significantly decreased from the SIA at postoperative week 1 (p < 0.0001 for all 3 weeks). SIA of the 23-gauge TSV group was significantly less than that of the 20-gauge standard vitrectomy group at each postoperative period (p = 0.001). SIA of the gas tamponade group in the 23-gauge TSV was significantly greater than that of the non-gas tamponade group at postoperative week one (p = 0.039). Shifts of axis to other meridians returned to preoperative meridian in 12 eyes (85.7%) for the 23-gauge group and seven eyes (43.8%) for the 20-gauge group. Combined phacoemulsification and pars plana vitrectomy (23-gauge and 20-gauge) could induce significant SIA at postoperative week 1, and decrease over 3 months. However, 23-gauge TSV showed less SIA and early stabilization compared to the 20-gauge standard vitrectomy.

Retrospective analysis of the utility of endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) in pancreatic masses, using a 22-gauge or 25-gauge needle system: a multicenter experience

Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) is now performed routinely in many advanced endoscopy centers and has enhanced the ability to diagnose pancreatic masses. However, there is uncertainty about which needle size is optimal for EUS-FNA of pancreatic masses. We aimed to evaluate the performance of the 22-gauge and 25-gauge needles in obtaining cytologic diagnosis of pancreatic masses. All cases that were referred for EUS-FNA for pancreatic masses between February 2001 and June 2007 were reviewed, and patients who underwent EUS-FNA using the 22-gauge and 25-gauge needle system were identified. In patients who underwent surgery, operative histopathological findings were compared with the cytopathological findings from EUS-FNA. A total of 842 patients with pancreatic masses detected on computed tomography (CT) and/or magnetic resonance imaging (MRI) and confirmed by EUS underwent EUS-FNA with the 22-gauge needle (n = 540) or the 25-gauge needle (n = 302). Results of EUS-FNA cytology findings were compared with the gold standard of surgical histopathological findings or long-term clinical follow-up. The sensitivity, specificity, PPV, and NPV of FNA were respectively 84%, 100%, 100%, and 73% [corrected] for the 22-gauge needle compared with 92%, 97%, 98%, and 87%, [corrected] respectively for the 25-gauge needle. No complications were noted in the 25-gauge needle group, compared with pancreatitis in 2% of the 22-gauge needle group. This retrospective comparative study shows that EUS-FNA with a 25-gauge needle system is a safe and reliable method for tissue sampling in pancreatic masses. The system is more sensitive and has a slightly [corrected] higher NPV than the standard 22-gauge needle. Our study suggests that perhaps the smaller caliber FNA needle causes less trauma during EUS-FNA and hence less complications. Further studies including randomized trials are needed.

A comparison of induced astigmatism in 20- vs 25-gauge vitrectomy procedures

Surgically induced astigmatism is an unwanted variable that can lead to poorer visual and refractive outcomes in patients undergoing vitrectomy even when a technically precise procedure has been performed. This study assesses the difference in surgically induced astigmatism (SIA) between the traditional 20-gauge vitrectomy and the newer 25-gauge sutureless technique by comparing pre- and post-procedure keratometry readings. The study is a retrospective consecutive case series of vitrectomies performed by a single surgeon. There were a total of 47 patients, eight with bilateral procedures, 24 who underwent the 20 gauge, and 31 who had the 25-gauge procedure. Patients were excluded for corneal altering pathology or scleral buckling procedures. Vector analysis of pre- and post-vitrectomy readings was performed using Alpin's method, facilitated by the ASSORT program version 4.1. Mean time at which post-operative keratometry readings were taken was 3.9 months (1-36). Mean astigmatism at presentation was 0.63 D and 0.92 D and at post-surgically follow-up 1.14 D and 0.91 D (20 and 25 gauge, respectively). Mean SIA was 0.66 D (SD=0.8 D) for the 20-gauge group and 0.27 D (SD=0.23 D) for the 25 gauge (P=0.037). The calculated figure of SIA variability representing the 95% CI for the maximum amount of SIA for each procedure was 2.26 D and 0.73 D for the 20- and 25-gauge procedure, respectively. The study shows that the 25-gauge technique involves a statistically significant reduction in the amount of SIA. This can ultimately lead to a better visual and refractive outcome for the patient.

25-GAUGE SUTURELESS VITRECTOMY VERSUS 20-GAUGE VITRECTOMY FOR THE REPAIR OF PRIMARY RHEGMATOGENOUS RETINAL DETACHMENT

To compare the anatomic and visual results and complications of 25-gauge transconjunctival sutureless vitrectomy versus conventional 20-gauge vitrectomy for the management of primary rhegmatogenous retinal detachment. A retrospective comparative analysis of 125 consecutive eyes from 125 patients with a minimum of 3 months follow-up was performed. All patients underwent primary vitrectomy with complete fluid air exchange, gas tamponade, and laser retinopexy. Excluded were eyes with prior retinal or vitreous surgery, and patients with inadequate follow-up. Sixty-four patients underwent 25-gauge transconjunctival sutureless vitrectomy and 61 patients underwent 20-gauge pars plana vitrectomy from September 2004 to April 2007. Primary endpoints included one surgery retinal reattachment success rate, visual outcomes, postoperative intraocular pressures and complications as determined by standard clinical evaluation. Baseline demographic and preoperative ocular characteristics showed no statistically significant difference between the two cohorts. The mean follow-up interval was 305.4 days for the 25-gauge group and 452.4 days for the 20-gauge group. The single operation success rate with one procedure was 58/64 (90.6%) for 25-gauge cases and 56/61 (91.8%) for 20-gauge cases, Fisher Exact Test (P = 0.801). All cases were attached at final follow-up and the anatomic success rate was 100% for each of the two cohorts. Preoperative best-corrected visual acuity (BCVA) was 20/125 and 20/169 for 25-gauge and 20-gauge cases, respectively (P > 0.5). The final follow-up mean BCVA was 20/34 and 20/36 for the 25-gauge and 20-gauge groups, respectively (P > 0.6). In the 25-gauge group two cases were complicated by hypotony that resolved uneventfully and one case developed postoperative choroidal and vitreous hemorrhage. In the 20-gauge group there was one case of sterile endophthalmitis and one case of vitreous hemorrhage. There was no significant difference between 25-gauge transconjunctival sutureless vitrectomy and 20-gauge vitrectomy for the repair of primary rhegmatogenous retinal detachments.

SURGICALLY-INDUCED INFLAMMATION WITH 20-, 23-, AND 25-GAUGE VITRECTOMY SYSTEMS

To evaluate postoperative intraocular inflammation induced in rabbit eyes subjected to surgery using different vitrectomy systems. The 20-, 23-, and 25-gauge vitrectomy were performed on a total of 12 rabbit eyes, divided into 3 respective groups, and 4 rabbit eyes were used as a normal control group. The surgery consisted of posterior vitreous detachment induction and core vitrectomy. The main outcome measures were operative time, volume of balanced saline solution consumed and the intravitreal total protein concentration, determined by bicinchoninic acid protein assays, obtained by vitreous tap on postoperative days 1, 3, and 7. The intravitreal protein averages in the 20-, 23-, and 25-gauge vitrectomy groups were, respectively, 31 +/- 4.1, 21 +/- 2.3, and 7 +/- 3.4 mg/mL on postoperative Day 1 (0.13 +/- 0.02 mg/mL in the control eye). The intravitreal protein concentration level was significantly lower with the 25-gauge than with 20- or 23-gauge vitrectomy (P < 0.001), and there were no significant differences in intravitreal protein between the 20- and 23-gauge system on postoperative days 1 and 3. At 7 days postoperatively, there were no significant differences in the intravitreal protein levels among the three groups. Significantly less balanced saline solution was consumed in the 25-gauge vitrectomy group (P < 0.001). Postoperative intraocular inflammation can vary among vitrectomy systems. A smaller gauge can minimize the inflammation associated with vitrectomy.

Comparison of One-year Outcomes between 23- and 20-gauge Vitrectomy for Preretinal Membrane

To compare the outcomes of transconjunctival sutureless 23-gauge vitrectomy and conventional 20-gauge vitrectomy 1 year after removal of preretinal membrane. Retrospective, consecutive, comparative case series. One hundred consecutive eyes with a preretinal membrane underwent either 23- and 20-gauge vitrectomy. The rate of improvement of the logarithm minimum angle of resolution visual acuity (VA) was calculated by the formula: (various postoperative values-preoperative values) x 100/ (1 year postoperative values-preoperative values). No significant differences were found between the groups in the preoperative and postoperative VAs. The VA improvement was higher and the surgically induced corneal astigmatism was lower 1 week postoperatively in the 23-gauge group compared with the 20-gauge group (P = .006 and P = .001, respectively). The flare values in the anterior chamber measured by laser flare meter preoperatively and 1 week postoperatively did not differ between the groups. The surgical time was significantly (P = .023) shorter in the 23-gauge group than in the 20-gauge group. No apparent complications developed in either group. Transconjunctival sutureless 23-gauge vitrectomy appears effective for preretinal membrane surgery with an acceptable safety profile. Transconjunctival sutureless 23-gauge vitrectomy may be a treatment option for preretinal membranes.

Comparison Between 20-Gauge and 23-Gauge Vitrectomy System in Primary Vitrectomy for Rhegmatogenous Retinal Detachment

Purpose: The efficacy of 20-gauge and 23-gauge vitrectomy system was investigated in primary vitrectomy for rhegmatogenous retinal detachment. Methods: Eyes that underwent primary vitrectomy without scleral buckling for the treatment of rhegmatogenous retinal detachment were followed up at least 6 months and were reviewed retrospectively. Anatomic results, functional outcomes, operation time and complications were compared between 20-gauge and 23-gauge groups. Results: Among 59 eyes of 59 patients, the 20-gauge group had 29 eyes of 29 patients and 23-gauge group had 30 eyes of 30 patients. Anatomic success after a single operation was obtained in 23 eyes (79.3%) of the 20-gauge group and 28 eyes (93.3%) of the 23-gauge group. Recurrence occurred in 6 eyes (20.7%) in the 20-gauge and in 2 eyes (6.6%) in the 23-gauge group. Retinal reattachment in all of these eyes was obtained through reoperation. Visual acuity improved logMAR 0.2 or more in 19 eyes (65.5%) of the 20-gauge group and 20 eyes (66.7%) of the 23 gauge group (p=0.153, 0.215). The average operation time of the 23-gauge group was 80.2 minutes, which was significantly shorter than the 94.8 minutes of the 20-gauge group (p=0.008). Transient ocular hypertension and progression of lens opacity were the most common complications in the both groups. Conclusions: Twenty-three-gauge transconjuctival sutureless vitrectomy achieved outcomes comparable with 20-gauge vitrectomy, with significantly shorter operation time in repair of rhegmatogenous retinal detachment. It is considered as a viable alternative to 20-gauge vitrectomy in selected cases.

Sclerotomy-related Retinal Breaks in Vitrectomy for Proliferative Diabetic Retinopathy: 20- vs 23-Gauge Systems

Purpose: To compare the rate of intraoperative sclerotomy-related retinal breaks (SRRB) between 20- and 23-gauge vitrectomy for proliferative diabetic retinopathy (PDR). Methods: Medical records of 62 consecutive eyes of 54 patients who underwent 20-gauge pars plana vitrectomy (PPV) and 63 consecutive eyes of 55 patients who received 23-gauge transconjunctival sutureless vitrectomy were retrospectively reviewed. Results: Three (4.8%) out of 62 eyes in the 20-gauge group had SRRB and 1 (1.6%) eye developed retinal detachment at 4 months postoperatively, while 2 (3.2%) out of 63 eyes in the 23-gauge group had SRRB and 1 (1.6%) eye developed retinal detachment at 3 months postoperatively. Conclusions: There were no significant differences in the rates of sclerotomy-related retinal breaks and sclerotomy-related retinal detachments between 20-gauge PPV and 23-gauge PPV for PDR.

23-gauge versus 20-gauge system for pars plana vitrectomy: a prospective randomised clinical trial

Aim:To compare the sutureless 23-gauge system with a standard 20-gauge system in pars plana vitrectomy.Methods:60 patients in two randomised groups were included in this prospective clinical trial. Pars plana vitrectomy...

Outcomes of 23- and 25-gauge transconjunctival sutureless vitrectomies for idiopathic macular holes

Background/aims:To assess the outcomes of 23-gauge sutureless transconjunctival vitrectomies (TSV), as compared with 25-gauge TSV in macular hole surgeries.Methods:A retrospective, consecutive, interventional case series of 47 eyes with idiopathic macular...

23-gauge sutureless vitrectomy and 20-gauge vitrectomy: a case series comparison

To directly compare the per-operative safety and efficacy of the 20- and 23-gauge vitrectomy systems as well as day 1 intraocular pressure (IOP). Data were collected on 50 consecutive vitrectomy cases performed using the 20-gauge system and 23-gauge sutureless vitrectomy. All surgeries were carried out by one surgeon (RLB) at a single centre. Data collected prospectively included indication for surgery, iatrogenic retinal tears, and operating times. Most common indications for surgery were macular hole, rhegmatogenous retinal detachment, diabetic vitreous haemorrhage (no tractional retinal detachment), and macular pucker. Intraocular tamponade with air, sulphur hexafluoride (SF6), hexafluoroethane (C2F6) or octafluoropropane (C3F8), or silicone oil was used in 25 patients in the 20-gauge group and 46 patients in the 23-gauge group. One scleral port required suture in patients who underwent 23-gauge vitrectomy (0.67%). Every 20-gauge patient had all the three ports sutured. The mean first day IOP was 22.88 mm Hg in the 20-gauge vs 17.58 mm Hg in the 23-gauge (P<0.001). Four patients in the 20-gauge group had an IOP >40 mm Hg compared to none in the 23-gauge group. In contrast, four patients had postoperative hypotony in the 23-gauge group compared to none in the 20-gauge group. The mean operating time for all the 50 cases in each group was 39.4 (20 gauge) vs 29 min (23 gauge) P<0.001. Our study indicates less risk of considerably raised IOPs and reduced surgical operating time with the 23-gauge system. Additional advantages observed included faster wound healing, diminished conjunctival scarring, improved patient comfort, and decreased postoperative inflammation.

Changes in Corneal Topography after 25-Gauge Transconjunctival Sutureless Vitrectomy versus after 20-Gauge Standard Vitrectomy

To evaluate the changes in regular and irregular corneal astigmatism after 25-gauge transconjunctival sutureless vitrectomy and 20-gauge standard vitrectomy. Prospective observational comparative case series. Thirty-two eyes of 32 patients undergoing 25-gauge transconjunctival sutureless vitrectomy and 25 eyes of 24 patients undergoing 20-gauge standard vitrectomy. Corneal topography was obtained preoperatively and at 2 weeks and 1 month postoperatively. The dioptric data of the central 3-mm zone of the cornea were decomposed using Fourier harmonic analysis into spherical power, regular astigmatism, asymmetry, and higher-order irregularity. None of the 4 Fourier indices changed throughout the observation period in the 25-gauge group. In the 20-gauge group, regular astigmatism, asymmetry, and higher-order irregularity were increased significantly at 2 weeks after vitrectomy (P<0.05, Wilcoxon signed-ranks test) and returned to preoperative levels by 1 month. The spherical power in the 20-gauge group did not change after surgery. For regular astigmatism, asymmetry, and higher-order irregularity, the 20-gauge group showed significantly greater surgically induced changes than the 25-gauge group (P<0.05, Mann-Whitney U test). Twenty-five-gauge transconjunctival sutureless vitrectomy does not induce significant changes in corneal topography and exerts little influence on the optical quality of the cornea.

Intraoperative Sclerotomy-related Retinal Breaks for Macular Surgery, 20- vs 25-Gauge Vitrectomy Systems

To compare the rate of intraoperative sclerotomy-related retinal breaks (SRRB) between 20- and 25-gauge vitrectomy systems for the correction of macular pucker (MP) and macular hole (MH). Retrospective interventional case series. Single institution review of 347 consecutive eyes of 333 patients between August 2003 and May 2005 receiving pars plana vitrectomy (PPV) for MP or MH repair. Eyes were excluded if they had any form of proliferative retinopathy, or if there was an intraoperative conversion of any sclerotomy from 25- to 20- gauge. Fourteen (6.4%) of 219 eyes in the 20-gauge group had SRRB vs 4 (3.1%) of 128 eyes in the 25-gauge group (Fisher exact test, P value = .22). There was a trend for slightly lower rates of intraoperative sclerotomy-related retinal breaks, single or multiple, with 25-gauge PPV compared with 20-gauge PPV, but the differences were not statistically significant.

Comparison of Visual Function After Epiretinal Membrane Removal by 20-Gauge and 25-Gauge Vitrectomy

To compare the efficacy and safety of 25-gauge vitrectomy with 20-gauge vitrectomy for macular pucker. Randomized clinical study. Sixty-seven eyes (67 patients) with macular pucker were prospectively and randomly assigned to undergo 20-gauge vitrectomy or 25-gauge vitrectomy as a control group. Main outcome measurements consisted of best-corrected visual acuity (BCVA), mean induced astigmatism, total operation time, and postoperative complications. The mean BCVA at baseline and at one month and six months after surgery was 20/78, 20/62, and 20/42, respectively, in the 20-gauge group, and 20/85, 20/45, and 20/40 in the 25-gauge group. A significant difference in change in the logarithm of the minimal angle of resolution of BCVA between 20-gauge and 25-gauge was found at one month (-0.10 vs -0.269, P < .001), but not at six months (-0.327 vs -0.276, P > .01). If faster visual improvement is desired, 25-gauge vitrectomy may be preferable to 20-gauge vitrectomy for macular pucker.

25-gauge, sutureless vitrectomy and standard 20-gauge pars plana vitrectomy in idiopathic epiretinal membrane surgery: a comparative pilot study

The aim of the study was to evaluate the safety and functional outcome of a small incision, sutureless vitrectomy in the treatment of idiopathic epiretinal membranes (ERM) compared with a standard 20-gauge vitrectomy system. Forty-six consecutive patients with idiopathic ERM were recruited for this study and prospectively evaluated. In group 1 (n=26) we used a transconjunctival sutureless 25-gauge vitrectomy system (TSV), patients in group 2 (n=20) were operated on using a standard 20-gauge vitrectomy system. The ERM was removed and the internal limiting membrane (ILM) was peeled in all eyes. Surgery-related complications, operating time, intraoperative balanced salt solution (BSS) consumption, postoperative discomfort, postoperative intraocular inflammation, lens opacification, and long-term visual outcome are reported and compared. No surgery-related complications were observed in either group. Operating time was shorter in group 1 compared with group 2 (mean 15.6 and 29.6 min respectively). Intraoperative amount of BSS consumption was less in group 1 (mean 28 ml in group 1 and 42 ml in group 2). Postoperative discomfort and intraocular inflammation were significantly reduced in the 25-gauge group. In the 20-gauge group cataract formation requiring surgery was observed in two eyes. Visual acuity improved significantly in both groups. The 25-gauge group improved on average by more lines of vision and the improvement in vision was more rapid. The TSV system is a safe and efficient surgical technique for ERM surgery. Operating time is significantly reduced, minimizing surgery-induced trauma, and reducing postoperative intraocular inflammation and the patients' discomfort. The incidence of cataract formation may be less using TSV. Postoperative recovery is accelerated.

Pars Plana Vitrectomy: Comparison of Three Techniques for the Treatment of Diabetic Vitreous Hemorrhage

To compare the outcome of three vitrectomy techniques in the treatment of diabetic vitreous hemorrhage. The study group included 38 patients (38 eyes) with diabetic vitreous hemorrhage. Three-port pars plana vitrectomy was used in 20 eyes, unimanual vitrectomy with indirect ophthalmoscopy in 10 eyes, and sutureless 25-gauge vitrectomy in 8 eyes. Main outcome measures were operative time, preoperative and postoperative visual acuity and intraocular pressure, and postoperative complications. Mean operative time was 66 minutes for three-port vitrectomy, 35 minutes for indirect vitrectomy, and 40 minutes for 25-gauge vitrectomy. Mean duration of follow-up was 26 months (range = 5 to 43 months). All three techniques successfully treated the vitreous hemorrhage, with similar best-corrected visual acuity outcome and similar complication rates. A greater tendency for hypotony on the first postoperative day was observed in the 25-gauge vitrectomy group. The three major techniques for treating vitreous hemorrhage are similarly effective and yield similar outcomes. The specific technique used should be selected on the basis of the clinical status of the patient and the skills of the surgeon.