23-gauge Sutureless Vitrectomy Research Articles

Prospective Evaluation of Results of Surgical Treatment of Patients with Idiopathic Macular Hole by Phacovitrectomy and Combined Cataract and Vitrectomy Surgery

Purpose of the study:The purpose of the study was to compare the morphological and functional results of the studied patients with idiopathic macular hole treated with a one-stage method (phacovitrectomy) and combined cataract and vitrectomy surgery.Material and methods:The study included 33 patients (33 eyes) with idiopathic macular hole treated at the Department of Retina and Vitreous Surgery in Lublin. Twenty-one eyes were surgically treated with phacovitrectomy (Group 1 MH). Twelve patients underwent two-stage, combined treatment with removal of the lens in the first stage and vitrectomy in the second (Group 2 MH). The assignment of patients to groups was random. All patients underwent 23-gauge sutureless vitrectomy with removal of the internal limiting membrane (internal limiting membrane peeling). SF6 gas was used as an intraocular tamponade at an isovolumetric concentration of 20% and face down position recommendation for 7 days. Cataract surgery was performed using the phacoemulsification method with an incision in the transparent part of the cornea with intracapsular, posterior chamber implantation of a monofocal lens. A 12-month observation period was established, measured from the date of vitrectomy performance, and in the case of a combined procedure, this period was extended by the time between each stage of treatment. At subsequent check-ups, the subjects underwent a complete ophthalmological examination, which included: best corrected distance visual acuity and best corrected near visual acuity, assessment of the anterior and posterior segments, in a slit lamp, measurement of retinal sensitivity in the macula using microperimetry, the Amsler test and optical coherence tomography examination of the macula.Results:In patients of the total studied group, an improvement in the best-corrected visual distance and near acuity was obtained, and in 88% retinal sensitivity in the macula was also achieved. In the group of patients subjected to phacovitrectomy (Group 1 macular hole) with an average minimum hole diameter of 487.48 µm before the procedure, after a one-year follow-up the mean best corrected distance visual acuity was 0.57 and best corrected near visual acuity 0.51, with macular retinal sensitivity of 26.65 dB. However, in the group of patients subjected to combined cataract and vitrectomy, an average minimum hole diameter of 521.58 µm 12 months after trans pars plana vitrectomy was performed as well as an average best corrected distance visual acuity of 0.64, best corrected near visual acuity of 0.5, and retinal sensitivity in the macula of 25.98 dB. There were no statistically significant differences between phacovitrectomy and the combined procedures in terms of the improvement in the values of distance and near visual acuity and macular retinal sensitivity 12 months after trans pars plana vitrectomy. A statistically significant improvement in retinal sensitivity in the macula was observed in Group 1 macular hole during the 12-month follow-up, while in the combined procedure group the improvement was not statistically significant.Conclusions:Vitrectomy is an effective method of treating maculopathy in the form of macular hole. Morphological and functional improvement was noted in all patients, regardless of the treatment method used. There were no statistically significant differences between phacovitrectomy and the combined procedure in terms of the improvement achieved in the values of distance visual acuity parameters, near vision and retinal sensitivity in the macula 12 months after trans pars plana vitrectomy. A common feature of patients with worse results on individual variables was a longer duration of the disease and a larger size of the hole prior vitrectomy.

Long-term Analysis of Surgically Induced Astigmatism after Combined Vitrectomy and Cataract Surgery versus Cataract Surgery Alone

Purpose: To compare the long-term changes in surgically induced astigmatism (SIA) in patients who underwent 23-gauge sutureless vitrectomy and cataract surgery together with patients who underwent cataract surgery only.Methods: We retrospectively reviewed SIA changes for 1 year after surgery in patients who received only cataract surgery using phacoemulsification (group 1) and patients who underwent 23-gauge sutureless vitrectomy and cataract surgery together (group 2). Flat keratometry (K1), steep keratometry (K2), and astigmatism axis were measured with automatic keratometry before and after the surgery. Vector analysis was used to calculate SIA at 1, 3, 6, and 12 months postoperatively. We then examined whether the SIA values at each time point were different between the two groups.Results: A total of 86 eyes were included in this study (group 1, n = 45; group 2, n = 41). The mean SIA values calculated at 1, 3, 6, and 12 months after surgery in group 1 were 0.83 ± 0.37, 0.69 ± 0.39, 0.60 ± 0.33, and 0.59 ± 0.33, respectively. In group 2, the values were 0.82 ± 0.47, 0.69 ± 0.38, 0.62 ± 0.28, and 0.61 ± 0.30, respectively. Over time, SIA decreased in both groups (all p < 0.001). There was no significant difference in the mean SIA between the two groups at each follow-up time point after surgery (p = 0.296, p = 0.728, p = 0.361, and p = 0.356, respectively).Conclusions: When 23-gauge sutureless vitrectomy and cataract surgery were performed together, the astigmatism change caused by surgery did not show a significant difference compared with that of the group who received cataract surgery only. Thus, 23-gauge sutureless vitrectomy may not significantly affect corneal astigmatism.

Air-Perfused 23-Gauge Sutureless Diabetic Vitrectomy for Control of Intraoperative Bleeding during Removal of Fibrovascular Membrane

ABSTRACTPurpose: To demonstrate the advantages and efficacy of an air-perfused membrane dissection to control intraoperative bleeding in 23-gauge sutureless vitrectomy for proliferative diabetic retinopathy with severe fibrovascular membranes.Meterials and Methods: A prospective, consecutive, interventional case series of 15 eyes that underwent air-perfused diabetic vitrectomy (air vitrectomy group) for removal of the membranes was compared with a retrospective, membrane-matched case series of 10 eyes that underwent conventional diabetic vitrectomy (conventional vitrectomy group). The main outcome measures were real vitrectomy time, intraoperative and postoperative complications, and anatomic and functional successes at the final examination.Results: The incidence of intraoperative retinal tears was 30% (3/10 eyes) in the conventional vitrectomy group and 20% (3/15 eyes) in the air vitrectomy group (p > 0.05). The postoperative complications such as vitreous hemorrhage or tractional retinal detachment were not common in both groups during the 6-month follow-up (p > 0.05). In addition, the final anatomic and functional success rates did not differ significantly between the groups (p > 0.05). However, the vitrectomy time was significantly shorter in the air vitrectomy group (67.0 ± 21.8 min) than in the conventional group (84.6 ± 21.1 min) (p = 0.04).Conclusion: Air-perfused vitrectomy showed comparable anatomic and functional success rates and shorter surgical time, compared with conventional vitrectomy in diabetic eyes with severe fibrovascular membranes. We suppose that the shortened surgical time in the air vitrectomy group is related to less intraoperative bleeding and more efficient hemostasis.

Vitreous rebleed following sutureless vitrectomy: Incidence and risk factors.

Purpose:This study aims to evaluate the incidence and risk factors for vitreous rebleed (VRB) following 25-gauge sutureless vitrectomy for vitreous hemorrhage (VH) in diabetic retinopathy.Methods:A retrospective review of 190 diabetic patients having undergone vitrectomy for VH at a tertiary eye care center was analyzed. Demographic data of patients along with risk factors such as blood sugar levels (BSL), blood pressure (BP), anticoagulant use, and pan-retinal photocoagulation status (PRP) were tabulated. Depending on the commencement of VRB, patients were divided into immediate rebleed-within 2 weeks and delayed rebleed-beyond 2–4 weeks.Results:Forty-one patients had VRB, out of which 18 patients had immediate VRB and 23 patients had delayed VRB. The average duration between vitrectomy and VRB was 3.28 months. Twenty-eight patients were male and 13 were females. Average age at presentation was 53.8 years. Thirty-four patients (82.9%) were found to have high BSL and 28 patients (68.3%) had high BP and they developed rebleed (P < 0.01) after an initial hemorrhage-free period (average = 5.15 months). Fifteen patients (36.6%) underwent first time PRP intraoperatively, and they had immediate rebleed (P < 0.01) without any hemorrhage-free period (average = 0.9 months). Eight patients (19.5%) were on perioperative anticoagulants; however, their statistical significance did not persist in the multivariable model. There were neither age nor gender predilection toward rebleed (P > 0.05).Conclusion:The incidence rate of VRB was found to be 21.6%. Age and gender did not contribute to rebleed. Intraoperative PRP was a risk factor for immediate rebleed. Poor glycemic and BP control was a risk factor for delayed rebleed.

A Modified Foveal Advancement Technique in the Treatment of Persistent Large Macular Holes.

To evaluate the outcomes of a new surgical technique on the closure of persistent large macular holes (MHs) PATIENTS AND METHODS:Data for 10 eyes of 10 patients who underwent surgical intervention for the treatment of large and persistent MHs were reviewed retrospectively. After entrance of the three-port transconjunctival 23-gauge sutureless vitrectomy instruments, a shallow perihole retinal detachment was formed by injecting a small amount of fluid with a 39-gauge /41-gauge subretinal cannula under the perihole (superior, temporal, and inferior sparing nasal bundle fibers) retina. Edges of the hole were brought closer with small, passive aspirations by a silicone-tipped cannula. After fluid-air exchange, a 39-gauge /41-gauge cannula was placed over the hole to remove submacular fluid. Then air was changed with 20% sulfur hexafluoride endotamponade. Mean minimum hole diameter was 691 μm ± 98 μm (range: 500 μm to 812 μm), and mean basal diameter was 1,604 μm ± 321 μm (range: 1,066 μm to 2,200 μm). Preoperative best spectacle-corrected visual acuities (BSCVAs) were lower than 20/200 in eight patients and were 20/200 in two patients. MHs were successfully closed in all eyes (100%). BSCVA did not change in two patients and were lower than 20/200. BSCVAs were 20/200 in six patients and greater than 20/200 in two patients. The ellipsoid zone (EZ) was lost in all patients. All the large and persistent MHs were successfully closed and stayed closed during follow-up period. However, increase in visual acuities was limited, which was related to the loss of the EZ. The authors' modified technique seems to be a good option for the surgical treatment of large and persistent MHs. [Ophthalmic Surg Lasers Imaging Retina. 2017;48:793-798.].

The role of day one postoperative review of intraocular pressure in modern vitrectomy surgery

BackgroundWith the introduction of sutureless 23-gauge (23G) vitrectomy, the risks for elevated intraocular pressure (IOP) and the need for day 1 review of IOP are less certain.AimsTo assess current practice...

Polyethylene Glycol-Based Synthetic Hydrogel Sealant for Closing Vitrectomy Wounds: An In Vivo and Histological Study.

PurposeWe conducted an in vivo study using Dutch pigmented rabbit eyes to test the usefulness of polyethylene glycol (PEG) sealant for the closure of sutureless sclerotomies in microincisional vitrectomy surgery (MIVS).MethodsThree-port, 23-gauge vitrectomy was performed on rabbit eyes. After air leakage was confirmed by the application of 0.625% povidone–iodine at the sclerotomy site, PEG sealant was subconjunctivally injected using a 27-gauge needle through conjunctival incisions to cover the sclerotomy wounds, following which it was polymerized by the application of xenon light for 60 seconds. Ophthalmological examinations and intraocular pressure measurements were conducted the day before and 1, 3, 5, and 7 days after surgery. The eyes were enucleated for histological evaluation 7 days after surgery.ResultsPEG sealant was rapidly polymerized by the application of xenon light after subconjunctival injection, and it firmly sealed the sclerotomies without air leakage, as confirmed by povidone–iodine dropping, in all cases. Conjunctival and scleral wounds closed with PEG sealant were successfully attached and remained intact till the end of the follow-up period. There was no sign of postoperative hypotony or infection in any eye, and no adverse effects of PEG sealant were found. In histological examination, linear scar formation and eosinophilic staining of collagen fibers were observed at the sclerotomy sites, while the sclerotomy tunnels appeared tightly closed.ConclusionsPEG sealant can be useful for the closure of sutureless 23-gauge vitrectomy incisions in rabbits.Translational RelevanceThe PEG sealant may become an effective option for closing vitrectomy incisions including pediatric cases.

Comparison of 25-gauge sutureless vitrectomy and 20-gauge vitrectomy in the treatment of posterior capsule opacification in pseudophakic children.

To compare the effectiveness and safety of pars plana capsulotomy and vitrectomy using 25-gauge tansconjunctival sutureless vitrectomy system and 20-gauge vitrectomy system for posterior capsule opacification (PCO) in pseudophakic children. Retrospectively study. Pars plana capsulotomy and vitrectomy using 25-gauge sutureless vitrectomy system was performed for PCO in the study group (32 eyes). Patients in the control group (34 eyes) underwent capsulotomy and vitrectomy using standard 20-gauge vitrectomy system, providing a comparison between 2 groups with regard to preoperative and postoperative best corrected visual acuity (BCVA), intraocular pressure (IOP), and intraoperative and postoperative complications. The two groups were performed consequentially. The patients ages ranged from 2 to 13y (means: 6.61±2.73y). Surgical technique, intraoperative and postoperative complications, visual acuity, IOP, and recurrent PCO were recorded. The surgical procedure was performed uneventfully in all patients. Visual acuity improved significantly in both groups. BCVA improved in 22 eyes (81.5%) in the study group and in 28 eyes (87.5%) in the control group. There was no statistical difference of visual acuity that were attainable in two groups (H=0.115, P=0.909). Mean postoperative IOP showed no significant difference between the groups at 1wk. All sort of PCO were accomplished by 20-gauge system, while 25-gauge system was effective for pearls style and 2 grade of fibrous PCO, and was insufficient to grade 3 of PCO. In the study group two cases were not accomplished by 25-gauge system while 20-gauge system conquered them. Compared with the control group, mean operative time for opening and closing the sclerotomy in the study group was considerably reduced. The mean follow-up was 38.2mo (range: 8-79mo). During the follow-up period, no incision leakage, corneal edema, vitreous loss, IOL damage, retinal detachment, recurrent PCO, or other complications were noted. Pars plana capsulotomy and vitrectomy using 25-gauge transconjunctival sutureless vitrectomy appeared to be a safe and effective approach for PCO in pseudophakic children. Combined sutureless surgery needed shorter setup time for sclerotomy and caused less surgical trauma than combined surgery with 20-gauge vitrectomy. Therefore, this type of procedure would be a good option for selected cases with PCO in pseudophakic children.

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.

Combined 23-gauge sutureless vitrectomy and clear corneal phacoemulsification for rhegmatogenous retinal detachment repair.

To assess the outcomes of combined 23-gauge sutureless vitrectomy and clear corneal phacoemulsification with intraocular lens implantation for rhegmatogenous retinal detachment (RRD) repair. This was a retrospective, consecutive, non-comparative, interventional case series of 30 eyes of 30 patients who underwent combined sutureless vitrectomy and clear corneal cataract surgery for the repair of RRD. The principal outcome measures were primary anatomical success rate, reasons for redetachment, final visual acuity, and surgical complications. Primary reattachment was achieved in 27 eyes (90.0%). The reasons for redetachment (3 eyes, 10%) were incomplete laser retinopexy, persistent chronic subretinal fluid, and proliferative vitreoretinopathy, respectively. The logarithm of the minimum angle of resolution visual acuity (mean±SD) improved from 0.76±0.74 preoperatively to 0.21±0.37 6 months' postoperatively (P<0.0001). Postoperative hypotony was not detected, but 1 eye (3.3%) had increased intraocular pressure (30mmHg) with spontaneous resolution. No endophthalmitis developed during follow-up. Macular pucker was detected in 3 eyes (10.0%). Combined 23-gauge sutureless vitrectomy and clear corneal phacoemulsification with intraocular lens implantation for RRD repair was proven safe and effective. It may provide not only the known advantages of conventional combined surgery, but also additional advantages such as less conjunctival fibrosis and the maintenance of stable intraocular pressure with low risks of postoperative hypotony and intraocular pressure elevation.

The Effects of the Scleral Suture in 23-Gauge Transconjunctival Sutureless Vitrectomy

Purpose: To evaluate the effects of scleral suture for the sclerotomy wound leakage and the clinical outcomes in 23-gauge transconjunctival sutureless vitrectomy with fluid-air exchange. Methods: A retrospective, comparative chart review of 75 eyes of 75 patients who underwent 23-gauge transconjunctival vitrecomy with fluid air exchange was performed. The patients were divided into 2 groups according to the scleral suture used at the end of the operation, sclera-sutured group and sutureless group. The amount of intraocular gas remnants was measured to compare the degree of sclerotomy wound leakage and the postoperative intraocular pressure (IOP) and reoperation rate were analyzed. Results: The mean IOP on postoperative day 1, 7 and 14 was 15.5 ± 4.0 mm Hg in the sclera-sutured group and 15.8 ± 6.2 mm Hg in the sutureless group, without statistical difference (p = 0.874). The percentage of intraocular gas remnants in eyes on postoperative day 1 was significantly higher in the sclera-sutured group (92.9 ± 9.7%) than in the sutureless group (82.4 ± 16.2%; p = 0.002) as well as on postoperative days 7 and 14. The reoperation rate was not statistically significantly different between the sclera-sutured group (6.5%) and sutureless group (9.1%; p = 0.683) Conclusions: In the cases of 23-gauge sutureless vitrectomy with fluid-air exchange, the scleral suture may be effective to prevent the sclerotomy wound leakage and maintain the intraocular gas longer, but there was no statistically significant difference in the final success rate between the 2 groups. However, as more intraocular gas remained in the sclera-sutured group than in the sutureless group statistically, the scleral suture should be considered in cases that require long-term gas tamponade. J Korean Ophthalmol Soc 2015;56(9):1353-1358

Trimanual technique using assistant-controlled light probe illumination and wide-angle viewing system in 23-gauge sutureless vitrectomy for diabetic tractional retinal detachment.

The authors propose a novel trimanual vitreous surgery using assistant-adjusted endoillumination during 23-gauge sutureless vitrectomy for severe diabetic tractional retinal detachment (TRD) under noncontact wide-angle viewing system. The trimanual sutureless vitrectomy under a wide-angle viewing system consisted of (1) a fourth-port microcannula in the inferior 6-o'clock position; (2) dynamic and specular illumination by an assistant-controlled light probe inserted through the fourth port; and (3) membrane dissection and bleeding control using two intraocular instruments. Six eyes of four patients who underwent trimanual diabetic vitrectomy were evaluated. Recurrent TRD was detected in one eye, and a second operation was performed. There were no intraoperative sclerotomy-related complications or postoperative hypotony, increased IOP, or endophthalmitis. Final anatomic and functional success was achieved in all six eyes. The trimanual technique is valuable for membrane dissection in severe diabetic TRD. The optimal and dynamic illumination provided a high-quality stereoscopic view under a wide-angle viewing system. Careful coordination between a surgeon and an assistant facilitates this technique.

Correlation between Intraocular Pressure and Bottle Heights during Vitrectomy

Purpose: To determine the correlation between intraocular pressure (IOP) and the bottle heights during vitrectomy using TONO-PENRXL applanation tonometer and IcareR PRO rebound tonometer. Methods: Twenty-four eyes of 24 patients who underwent 23-gauge sutureless vitrectomy were evaluated. After complete vitrectomy, the IOP was gradually increased by lifting the irrigation bottle height from the trocar insertion site by 40 cm, 45 cm, 50 cm, and 55 cm. The distance between the floor and patient's eye was consistent in all cases (105.5 cm). Before the removal of 23-gauge microcannulas, IOP was measured five times using each of the two methods, Tono-PenRXL and IcareR PRO. Results: The mean IOPs were 8.25 ± 0.35 mm Hg for TONO-PENRXL and 8.96 ± 0.32 mm Hg for IcareR PRO at 40 cm bottle height. As the bottle height increased, the differences in IOP was also increased, 10.71 ± 0.37 mm Hg at 45 cm, 14.18 ± 0.39 mm Hg at 50 cm and 17.93 ± 0.40 mm Hg at 55 cm for TONO-PENRXL and 11.48 ± 0.31 mm Hg at 45 cm, 14.64 ± 0.31 mm Hg at 50 cm and 18.13 ± 0.38 mm Hg at 55 cm for IcareR PRO. In TONO-PENRXL, the linear equation was Y = 0.65 X 18.108 (R = 0.794, p = 0.000) and the quadratic equation was Y = 0.013 X 0.569 X + 10.446 (R = 0.801, p = 0.000). In IcareR PRO, the linear equation was Y = 0.614 X 15.842 (R = 0.820, p = 0.000) and the quadratic equation was Y = 0.010 X 0.306 X + 5.688 (R = 0.825, p = 0.000). The results show correlation of the quadratic equation was stronger than the linear equation in both tonometers. Conclusions: The differences of IOP were positively correlated with bottle heights in the form of a curve during vitrectomy. Therefore, the patients who are susceptible to retina or optic nerve damage during vitrectomy should be closely monitored. J Korean Ophthalmol Soc 2015;56(5):727-731

Sutureless 25-Gauge Vitrectomy for Rhegmatogenous Retinal Detachment Caused by Superior Breaks Using Air Tamponade.

This study was aimed to evaluate the efficacy and safety of 25-gauge sutureless vitrectomy in repairing primary rhegmatogenous retinal detachment (RRD) with air tamponade. This is a prospective, clinic-based, case series. Twenty consecutive eyes of 20 patients with primary RRD caused by superior breaks of less than a month underwent transconjunctival sutureless 25-gauge vitrectomy with intraocular air tamponade. Patients who had a follow-up of less than 6 months were excluded. Outcome measures included best corrected visual acuity (BCVA), reattachment rate by a single procedure, final reattachment rate by additional procedures, and complications. The mean follow-up was 10 months (range, 6-15 months). The proportion of eyes with BCVA of between 20/200 and 20/70 increased significantly from 15% at baseline to 65% on day 14 (P = 0.024). At final follow-up, 15%, 60%, and 25% had BCVA worse than 20/200, between 20/200 and 20/70, and better than 20/70, respectively. The mean BCVA was significantly better than baseline (logMAR, 1.4) by day 14 (logMAR, 0.87). The reattachment rate by a single procedure was 70%, and the final success rate was 100% after 1 additional procedure. The primary success rate increased to 77.8% after excluding 2 eyes with proliferative vitreoretinopathy grade C1. High myopia and large retinal break were 2 other conditions associated with failed primary reattachment. No postoperative complication was observed. Selected eyes with primary RRD may gain the benefit of early visual recovery when treated with 25-gauge vitrectomy and air tamponade.

Combined Ahmed glaucoma valve implantation and 23-gauge vitrectomy for neovascular glaucoma with vitreous hemorrhage

Objective To evaluate the clinical efficacy of Ahmed glaucoma valve (AGV) implantation combined with transconjunctival sutureless 23-gauge vitrectomy(23G-TSV) for treatment of neovascular glaucoma (NVG) with vitreous hemorrhage.Methods 25 eyes of 25 patients with neovascular glaucoma and vitreous hemorrhage were treated with combined AGV implantation and 23G-TSV.The intraocular pressure(IOP),best corrected visual acuity,success rate and postoperative complications were followed up for 6-12 months.The avevage follow up time was (9.96 ± 1.93) months.Results The IOP was(15.94±6.05),(14.76±2.39),(17.12±6.06),(17.44±2.75) and (18.96 ± 3.56) mmHg (1 mm Hg =0.133 kPa) at 1 day,1 week,1 month,3 months and the last follow-up postoperatively.Compared with pre-operative IOP of (48.12 ± 7.29) mmHg,the IOP was significantly(t =16.733,P ＜ 0.05 ; t =21.961,P＜0.05;t =16.917,P＜0.05 ;t =17.609,P＜0.05 ;t =18.091,P＜0.05)decreased after surgery; The total success rate was 84.0％ at final follow-up; The visual acuity was improved in all patients.Conclusion AGV implantation combined with 23G-TSV is effective for treating NVG with vitreous hemorrhage. Key words: Implants, drainage, glaucoma, Ahmed; Vitrectomy, 23G; Hemorrhage, Vitreous; Glaucoma, neovascular

Pars Plana Vitrectomy for Vitreous Floaters

Pars Plana Vitrectomy for Vitreous Floaters

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

Intraoperative endoscopic observation of sclerotomy site after cannula removal for 23-gauge vitrectomy

BackgroundThe purpose of this study was to determine the incidence of vitreous incarceration in sclerotomy after cannula removal during 23-gauge vitrectomy.MethodsThirty-seven eyes underwent 23-gauge sutureless vitrectomy. Oblique sclerotomies were made parallel to the limbus and tangentially to the sclera. Once past the trocar sleeve, the angle was changed to 90 degrees perpendicular to the surface and the trocar and cannula inserted. Vitreous gel was removed until the intraocular edge of the infusion cannula was free from the gel. The cannula was extracted with insertion of a light probe. The sclerotomy site was evaluated endoscopically through another cannula in 32 eyes; in five eyes, another infusion tube was inserted into the cannula to maintain intraocular pressure, the original infusion was removed, and the sclerotomy site observed.ResultsNo vitreous incarceration occurred in 30 (94%) eyes when one cannula was removed with insertion of a light probe, and minimal incarceration occurred in two (6%) eyes. No incarceration occurred in five eyes with observation of the infusion site.ConclusionThe incidence of vitreous incarceration is low when a light probe or vitreous cutter is inserted. Inserting the light probe through the cannula during its removal and creating an oblique sclerotomy may reduce vitreous incarceration.

OUTCOMES AFTER COMBINED 1.8-MM MICROINCISION CATARACT SURGERY AND 23-GAUGE TRANSCONJUNCTIVAL VITRECTOMY FOR POSTERIOR SEGMENT DISEASE

The aim of the study was to retrospectively review indications, intraoperative and postoperative complications, and outcomes of combined coaxial microincision cataract surgery and 23-gauge vitrectomy for posterior segment disease. The outcomes and findings of surgery in 50 patients (50 eyes) who underwent coaxial microincision cataract surgery and foldable intraocular lens implantation combined with 23-gauge vitrectomy for a variety of indications between January 2010 and March 2012. No posterior capsule tear was observed during surgery. Intraoperatively, a retinal break was found in 9 eyes (18%), which were successfully treated with laser and/or cryotherapy. Corneal suture was done in 6 eyes (12%), 5 of them left and 1 right. Sclerotomy was sutured in 2 left and 2 right eyes, respectively, a total of 4 eyes (8%). In 1 case, 23-gauge vitrectomy was converted to 20-gauge vitrectomy. The postoperative intraocular pressure (millimeters of mercury, mean ± standard deviation) was 16.7 ± 9.8. Hypotony (intraocular pressure < 9 mmHg) occurred in 9 eyes (18%). In 1 eye (2%) posterior iris synechia were observed 2 weeks after surgery, and intraocular pressure was >40 mmHg. Intraocular pressure was normalized after Nd:YAG laser iridotomy. Fibrin reaction in the anterior chamber was observed in 1 eye (2%) Day 1 after surgery. Posterior capsule opacification, which required Nd:YAG laser capsulotomy, was observed in 11 eyes (22%) during the follow-up. Combined sutureless coaxial microincision cataract surgery and 23-gauge vitrectomy offers the advantages of both coaxial microincision cataract surgery (less wound leakage, good anterior chamber stability, and safety) and 23-gauge vitrectomy (decreased inflammation and faster rehabilitation after surgery).

Pronostic anatomique et fonctionnel des décollements de rétine secondaires après chirurgie maculaire sans suture

To evaluate the incidence, characteristics and risk factors for rhegmatogenous complications of transconjunctival sutureless 23-gauge vitrectomy (TSV) in macular surgery. The results were correlated with those reported in the literature. Multicentric retrospective study of a cohort of patients undergoing macular surgery by 23-gauge TSV between January 2009 and June 2010. Four hundred and seventy-four patients divided into: epiretinal membrane (MEM) (n=279), vitreomacular traction (n=65) and idiopathic macular hole n=130. Forty-three percent of patients were pseudophakic. Posterior vitreous detachment (PVD) was absent in 60% of cases and was therefore systematically performed intraoperatively. It was seen that 1.7% of patients developed retinal tears and 2.7% retinal detachment with a higher incidence in the vitreomacular traction (VMT) group and the group in which the PVD was performed intraoperatively. Rhegmatogenous lesions were localized mainly in the inferior retina in the macular hole group. Results are consistent with the TSV literature. Their location does not appear to be related to the sclerotomies or handedness as in 20-gauge surgery, probably due to sclerotomy trocars. Localization of rhegmatogenous lesions in the inferior retina in macular hole surgery suggests a role of gas in this subgroup. In addition to instrument-retinal touch, the performance of a surgical PVD represents a major independent risk factor for retinal detachment (RD). Even with limited macular surgery, it is essential to check the retinal periphery for 360 degrees, especially for VMT and intraoperative PVD, and especially inferiorly in the case of gas tamponnade.