23G PPV Research Articles

Curative effect of 23G PPV combined with Tongmai Tangyanming Capsule on curative effect and serum insulin related factors in patients with PDR

Curative effect of 23G PPV combined with Tongmai Tangyanming Capsule on curative effect and serum insulin related factors in patients with PDR

Frequency of Post-Operative Hypotony in 23 Gauge and 25 Gauge Pars Plana Vitrectomy in Advanced Diabetic Eye Disease

Purpose: To compare the frequency of post-operative hypotony between 23G PPV and 25G PPV in advanced diabetic eye disease.
 Study Design: Quasi experimental study.
 Place and Duration of Study: Study was conducted at department of Ophthalmology, Lahore General Hospital, Lahore from 7th April 2016 to 6th October 2016.
 Methods: Total 100 cases of advanced diabetic eye disease with age ranging from 25 – 65 years and either gender were selected. Patients with nystagmus and claustrophobia, lamellar macular holes, epiretinal membrane and neovascular glaucoma were excluded. Patients were divided by lottery method into 2 groups. Data of the patient i.e. name, age, sex, patient’s registration number and address was recorded. Every patient had detailed preoperative work-up; including best corrected visual acuity by Snellen’s chart, intraocular pressure by applanation tonometer, indirect ophthalmoscopy and B-scan for retinal status. Group A underwent 23G PPV and group B underwent 25G PPV. Patients were followed after 24 hours of surgery to measure intraocular pressure to access hypotony.
 Results: Mean age of patients in group A was 50.16 ± 10.40 years and in group B was 50.26 ± 9.91 years. Out of 100 patients 57 (57.0%) were females and 43 (43.0%) were males, with female to male ratio of 1.1:1. Post-operative hypotony was seen in 24 (48.0%) patients with 23G PPV and 02 (4.0%) patients with 25G PPV (p-value = 0.0001).
 Conclusion: This study concluded that the frequency of post-operative hypotony in 23G Pars Plana Vitrectomy was higher as compared to 25G Pars Plana Vitrectomy in advanced diabetic eye disease.
 Key Words: Diabetic retinopathy, Pars Plana Vitrectomy, Hypotony.

Transscleral Extraction of an Intraocular Foreign Body from the Posterior Segment of the Eye without Pars Plana Vitrectomy.

Penetrating eye trauma with an intraocular foreign body is very frequent, especially in men in their productive age. Pars plana vitrectomy would be the standard surgical method at our department. However, in indicated cases (metallic intraocular bodies in the posterior eye segment in young patients with well transparent ocular media without detached ZSM and without any evident vitreoretinal traction) transscleral extraction of the intraocular foreign body is performed using the exo magnet, eventually endo magnet with aminimal PPV without PVD induction under the visual control of endo-illumination. Between June 2003 and June 2018, 66 eyes of 66 patients diagnosed with apenetrating eye trauma caused by an intraocular foreign body located in the posterior eye segment were treated. In 18 eyes (27,3 %) with ametallic foreign body in vitreous (body) or in retina, no PPV or aminimal PPV without PVD was used as asurgical method. In the remaining 48 eyes (72,7 %), astandard 20G, respectively 23G PPV method were used together with PVD induction and the foreign body extraction via endo or exo magnet. As demonstrated by our survey/study, in the cases of athoroughly considered indication an experimented vitreoretinal surgeon can perform asafe NCT transscleral extraction from the posterior eye segment via exo magnet, eventually endo magnet under the visual control of acontact display system with aminimal PPV. Thereby, the surgeon can enhance the patient´schance to preserve their own lens and its accommodative abilities as well as reduce the risk of further surgical interventions of the afflicted eye.

Prognostic value of ocular trauma score for open globe injuries associated with metallic intraocular foreign bodies

BackgroundThe prognostic value of the ocular trauma score (OTS) in patients who underwent 23-gauge pars plana vitrectomy (23-G PPV) for surgical removal of posterior segment metallic intaocular foreign bodies (IOFB) was evaluated.MethodsPatients who underwent 23-G PPV for surgical removal of retained metallic IOFBs were retrospectively analyzed. OTS score for each patient was calculated and raw scores were converted to their corresponding OTS categories. The final VAs in study patients were compared with their respective OTS categories.ResultsTwenty-five eyes from 25 patients were examined. Twenty-four (96%) of the patients were male, and the mean age was 34 ± 12 years. The time from injury to 23-G PPV was 9 ± 4 days. Fourteen (56%) patients had zone 1 trauma, eight (32%) patients had zone 2 trauma, and three (12%) patients had zone 3 trauma. Postoperative visual acuity was ≥ 20/200 in 14 (56%) of the patients and ≥ 20/40 in seven (28%) eyes. At the final visit, anatomical success was achieved in 86% of patients with retinal detachment at presentation. No statistically significant differences were found between our final VAs and OTS scores.ConclusionOTS, which provides prognostic information after general ocular trauma, may also provide valuable prognostic information for patients who undergo 23-G PPV for the surgical removal of metallic posterior segment IOFBs.

Pediatric Traumatic Retinal Detachment: Clinical Features, Prognostic Factors, and Surgical Outcomes.

Purpose We report the clinical characteristics, prognostic factors, and surgical outcomes for 23-gauge pars plana vitrectomy (23-G PPV) in pediatric cases of traumatic retinal detachment (RD). Methods Medical records of pediatric patients who underwent 23-G PPV to treat traumatic retinal detachment were retrospectively reviewed. These patients underwent a follow-up examination at least 1 year following surgery. Associations between various preoperative factors and anatomical and visual outcomes were analyzed. An Ocular Trauma Score (OTS) and a Pediatric Ocular Trauma Score (POTS) were calculated for each patient. Raw scores were converted to their corresponding OTS and POTS categories. Final visual acuities by categories were compared with those in the OTS and POTS studies. Results The mean age of the patients was 9 ± 4 years, and the male-to-female ratio was 4.7 : 1. The mean follow-up time was 23 ± 14 months. Anatomical success was achieved in 72% of the eyes, and functional success (>5/200) was achieved in 37% of the eyes. Functional success was less common among patients with visual acuities less than hand motion, macula-off retinal detachment, proliferative vitreoretinopathy at presentation, and recurrent retinal detachment during follow-up. When we compared the categorical distribution of final visual acuities in all categories, our results were significantly different than those suggested by OTS and POTS. Conclusions Visual outcomes are poorer compared to anatomical outcomes. OTS and POTS do not provide reliable prognostic information if the patient has RD. Presenting visual acuity, the presence of macula-off RD, and PVR are all important predictors of final visual acuity.

Bevacizumab as an adjunct to vitrectomy for diabetic retinopathy: A retrospective study

Purpose: The purpose of this study is to evaluate the effect of a single preoperative injection of intravitreal bevacizumab (IVB) on the visual and anatomical outcome of patients undergoing 23-gauge pars plana vitrectomy (23G PPV) for proliferative diabetic retinopathy (PDR). Materials and Methods: Medical record from patients undergoing vitrectomy for PDR were retrospectively analyzed for the last 3 years. IVB has been a routine procedure for patients fulfilling eligibility criteria for the past 3 years. Patients who did not receive IVB preoperatively were assigned as control group (Group A). Patients who received a single IVB injection (1.25 mg in 0.05 ml) preoperatively were assigned to Group B. Medical record of 100 patients who had completed 12-month follow-up were included in each group. Results: The primary outcome measure was visual outcome which was better in Group B as compared to Group A, anatomical outcome observed was 65% patients in Group A and 85% patients in Group B. The secondary outcomes were intraoperative hemorrhage and postoperative vitreous hemorrhage (VH). Intraoperative hemorrhage was seen in 40% patients in Group A and 20% patients in Group B, whereas postoperative VH was seen in 45% patients in Group A and 15% patients in Group B. Conclusion: Preoperative use of bevacizumab achieves excellent anatomical and functional success in majority of patients undergoing PPV for PDR and significantly reduced occurrence of postoperative VH. The results are encouraging when combined with transconjunctival 23 GPPV.

Outcomes of 23-gauge pars plana vitrectomy combined with phacoemulsification and capsulotomy without intraocular lens implantation in rhegmatogenous retinal detachment associated with choroidal detachment.

Rhegmatogenous retinal detachment associated with choroidal detachment (RRDCD) is a special type of complex retinal detachment, and usually has a poor prognosis. This study aimed to assess the anatomical outcomes of 23-gauge pars plana vitrectomy (23G PPV) combined with phacoemulsification (phaco) and capsulotomy without intraocular lens (IOL) implantation in patients with RRDCD.Seventy-six consecutive patients with RRDCD, who underwent retinal repair surgery from January 2010 to December 2014, were retrospectively analyzed. Forty patients underwent 23G PPV + phaco + IOL implantation, and 36 underwent 23G PPV + phaco + capsulotomy without IOL implantation (i.e., aphakia). All cases were filled with silicone oil. The follow-up time was 6 months after silicone oil was removed. Multivariate logistic regression analysis was the statistical method used.The overall retinal anatomical reattachment rate was 58% (44/76): 40% (16/40) of patients receiving 23G PPV + phaco + IOL implantation; and 78% (28/36) of patients receiving 23G PPV + phaco + capsulotomy + aphakia (P = .007).Surgical repair using 23G PPV + phaco + capsulotomy without IOL implantation can improve anatomical reattachment rates in patients with RRDCD.

Retained intraocular metallic foreign body causing retinal detachment

A 60 year old farmer presented on 4th Sept, 2015with progressive diminution of vision in the right eye following trauma while hammering about a month previously. His vision was Hand Movement only in the right eye and 6/6 in left eye. The anterior segment showed normal findings, except mild anterior chamber reaction and an early cataract in the right eye. The left eye was normal except for an early age-related cataract. Fundoscopy revealed retained intra-ocular foreign body (ROOFB, subtotal RD with macula off in right eye. Interestingly, no entry wound was found. A B-scan and CT scan of the brain and orbit confirmed RIOFB and RD. On 9th September 23G PPV was done and RIOFB was removed. Fluid-air exchange, endolaser and silicon oil injection were done to attach the RD. On 6th February 2016 a cataract extraction with intraocular lens implantation and silicon oil removal was performed which improved the patient’s vision to 6/18p.

23-gauge transconjunctival vitrectomy in eyes with pre-existing functioning filtering blebs.

BackgroundWe investigated the outcome of 23-gauge transconjunctival pars plana vitrectomy (23G PPV) for the treatment of vitreoretinal disorder in patients with prior trabeculectomy.MethodsWe retrospectively reviewed medical records of 23G PPV in 11 eyes that had functioning filtering blebs after trabeculectomy. The main outcome measures were the visual acuity, intraocular pressure (IOP) and subconjunctival fluid height in bleb by anterior segment optical coherence tomography (OCT) before and after the surgery.ResultsEyes that had 23G PPV showed improvement of visual acuity after the surgery (P =0.003). Mean IOP was 13.82 mmHg before 23G PPV and 15.82 mmHg at 6 months postoperatively, which was statistically insignificant (P = 0.758). The bleb was observed before and after surgery using anterior segment OCT, and the difference in subconjunctival fluid was not statistically significant (P =0.172).Conclusions23G PPV did not adversely affect bleb function in eyes with prior trabeculectomy.

Clinical outcomes of idiopathic macular epiretinal membrane removal by 23G vitrectomy with or without internal limiting membrane peeling

Objective To evaluate the clinical outcomes of idiopathic macular epiretinal membrane (IMEM) by 23G vitrectomy with or without internal limiting membrane peeling.Methods A total of 40 eyes in 40 patients diagnosed as IMEM underwent 23G pars plana thre-port vitrectomy (23G PPV).The macular ERM alone was removed in 20 eyes (non-ILM peeling group).Both ERM and ILM peeling were performed in another 20 eyes (ILM peeling group).All patients underwent removal of ERM with assistance of triamcinolone acetonide.For patients who underwent ILM peeling,indocyanine green dye was used to stain the ILM.ILM was peeled off up to the marginal of macular vessels arch.The patients in ILM peeling group and non-ILM peeling group had postsurgical follow-up for (15.85±3.79) months and (16.45±3.72) months respectively.There were no significant differences in gender,age,OD/OS,preoperative bestcorrected visual acuity (BCVA),preoperative central macular thickness (CMT),preoperative total macular volume (TMV) and follow-up time between the two groups (P＞0.05).Intraoperative or postoperative complication was recorded during the follow-up period.At the final visit,the differences in BCVA,CMT and TMV between the two groups were analyzed,so did the correlations between BCVA and CMT or TMV in each group at the same time.Results There was no recurrence of an ERM or severe complications,such as retinal detachment and endophthalmitis in either group.The mean BCVA of ILM peeling group and nonILM peeling group was 0.53 ± 0.27 and 0.54 ± 0.26 respectively at the final visit.Postoperative BCVA improved significantly in both groups with significant difference (t=5.035,4.964; P＜0.05).The was no difference of postoperative BCVA between two groups (t =0.176,P＞ 0.05).The mean CMT was (343.55 ± 48.74) μm and (311.70±42.48) μm,and the mean TMV was (7.78±0.40) mm3 and (7.88±0.43) mm3.CMT (t=9.508,8.549) and TMV (t =11.098、15.372) revealed a significant decrease in both groups with significant difference (P ＜ 0.05).The postoperative CMT in the ILM peeling group was significantly higher than that in the non-ILM peeling group (t=-2.203,P＜0.05).No difference was found between the two groups in terms of TMV (t =0.755,P＞0.05).Furthermore,no correlation was observed between postoperative BCVA and CMT (r =0.244,0.266 ; P ＞ 0.05) or TMV (r =-0.096,0.157; P＞0.05).Conclusions 23G PPV combined with or without ILM peeling is an efficient and safe treatment for IMEM.ILM peeling appears to have similar effect on the long-term visual outcomes comparing with non-ILM peeling,combined with much thicker postoperative CMT. Key words: Macula lutea; Membranes; Surgical procedures, minimally invasive; Vitrectomy

Retrospective Comparison of 25- and 23-Gauge Microincision Vitrectomy Surgery and 20-Gauge Vitrectomy for the Repair of Macular Hole Retinal Detachment.

To compare the anatomical and functional outcomes of 25- and 23-gauge microincision vitrectomy surgery (25G and 23G MIVS) instrumentation with the standard 20G pars plana vitrectomy (20G PPV) system in the treatment of primary macular hole retinal detachment (MHRD). A retrospective comparative study. Forty-six eyes of 45 patients with MHRD underwent pars plana vitrectomy from March 1, 2006 to April 31, 2011. Fourteen, 13, and 19 eyes underwent 20G PPV, 23G MIVS, and 25G MIVS, respectively. The analysis included characteristics of the patients, single operation reattachment rate, final reattachment rate, closure rate of the macular hole, and rate of complications. The median follow-up period was 273 days. Preoperative characteristics were similar in the 3 groups. The single operation success rate was 11 (79%) of 14 for 20G PPV, 10 (77%) of 13 for 23G MIVS, and 14 (74%) of 19 for 25G MIVS (P = 0.95). The closure rate of the macular hole was 9 (64%) of 14 for 20G PPV, 9 (69%) of 13 for 23G MIVS, and 11 (58%) of 19 for 25G MIVS (P = 0.78). One hundred percent of patients achieved final reattachment after multiple surgeries, excluding 2 patients who dropped out during the follow-up period. Rates of visual recovery and complications, including hypotony, were similar for all 3 procedures. The outcomes of 25G and 23G MIVS for the management of MHRD did not differ significantly from 20G PPV. Microincision vitrectomy surgery may be considered an alternative treatment, even for MHRD.

Iatrogenic retinal breaks in 20-G versus 23-G pars plana vitrectomy

The purpose of this study was to compare the incidence of iatrogenic anterior retinal breaks in 20-G vitrectomy (PPV) with transconjunctival 23-G PPV. Retrospective, observational review study involving consecutive patients undergoing PPV in a single center in the UK during a 2-year period. Sclerotomy-related entry-site breaks (ESB) were found in 50/628 (7.9 %) 20-G PPV cases and 5/296 (1.7 %) 23-G PPV eyes (p<0.0001*). Anterior non-sclerotomy iatrogenic breaks (ANSB) were present in 55/628 (8.7 %) 20-G PPV cases and 18/296 (6.1 %) 23-G PPV eyes (p=0.19). The incidence of total anterior iatrogenic breaks (ANSB + ESB) was 105/628 (16.7 %) for 20-G PPV and 23/296 (7.8 %) for 23-G PPV (p=0.002*). Univariate analysis showed that posterior vitreous detachment induction was the only risk factor significantly associated with the development of anterior retinal breaks for both 20-G and 23-G PPV. Multivariate logistic model of risk factors for development of iatrogenic retinal breaks demonstrated that 23-G PPV was the most important factor reducing the risk of anterior breaks (p<0.0001*). We report the largest series of patients undergoing 20-G and 23-G vitrectomy, where 23-G vitrectomy was associated with a significantly lower incidence of anterior iatrogenic retinal breaks.

Endophthalmitis in the Era of Small Gauge Transconjunctival Sutureless Vitrectomy—Meta Analysis and Review of Literature

Purpose: The goal of this study was to review, evaluate, and perform a meta-analysis on the current literature that reports rates of postoperative endophthalmitis after small gauge transconjunctival sutureless vitrectomy (TSV) and compare it to 20-gauge pars plana vitrectomy (20G PPV). Methods: We performed an extensive review of the current literature. We included only large comparative institutional reviews. Meta-analysis of these reviews was performed. Results: We found six large retrospective comparative cases series on the 25-gauge (25G) TSV as compared to 20G PPV. The test for homogeneity for the meta-analysis indicates that the studies are not homogeneous and therefore the evidence is tentative. Conclusion: We cannot conclude that 25G TSV has a higher rate of postoperative endophthalmitis compared to the 20G PPV. Future retrospective or prospective trials need to take into consideration multiple factors.

The options to minimize the surgical trauma to treat ocular diabetic complications and to improve postoperative recovery and quality of life require an individualized approach

Within the past ten years, small incision pars-plana vitrectomy, and refined microsurgical techniques, together with the introduction of various intravitreally applied drugs, significantly improved the anatomical and functional outcome. Unfortunately many diabetic patients with vitreoretinal complications also have cataract. In diabetic retinopathy, the benefit of simultaneous cataract surgery was long under debate due to possible side effects such as fibrinous reaction or secondary glaucoma. We review recent reports about the results of PPV for complication of diabetic retinopathy and the influence of a simultaneous cataract surgery, that compare different surgical approaches. Pars plana vitrectomy carried out with conventional 0,9 mm incisions (20G PPV) were related to higher incidences of postoperative inflammatory reactions and to a higher frequency of postoperative hypertensive events as compared to small incision vitrectomy (23G PPV). Postoperative recovery was faster in eyes with 23G surgery than after 20G surgery, with no delay by a simultaneous cataract surgery. A 23G-PPV improves the postoperative recovery and the quality of life for the diabetic patient. Cataract is no longer an obstacle for a vitreoretinal surgery. Postoperative recovery is faster and the new technique has less side effects than the conventional technique. In the future, a drug assisted vitrectomy will further reduce the surgical trauma. However, the new options are not equally benefitial for all patients. A further improvement in the quality of life will require a more individualized approach of microsurgical treatment for ocular complications of diabetes.

Microincision Vitrectomy Surgery and Intravitreal Bevacizumab as a Surgical Adjunct to Treat Diabetic Traction Retinal Detachment

To investigate the feasibility and efficacy of microincision vitrectomy surgery (MIVS) combined with intravitreal bevacizumab (IVB) as a surgical adjunct for treating traction retinal detachment (TRD) secondary to severe proliferative diabetic retinopathy (PDR). Retrospective, comparative, consecutive, interventional case series. Seventy-one eyes of 59 consecutive patients who underwent primary vitrectomy for diabetic TRD and were followed up for more than 6 months after surgery. Eyes that received IVB (1 mg) as a preoperative adjunct followed by MIVS (IVB/MIVS group) from November 2005 through December 2007 were compared with eyes that underwent conventional 20-gauge pars plana vitrectomy (20-g PPV group) from September 2003 through October 2005. Primary and ultimate anatomic success, intraoperative and postoperative complications, and final visual success with at least 6 months of follow-up. This series included 38 eyes (33 patients) in the IVB/MIVS group and 33 eyes (26 patients) in the 20-g PPV group. The primary and ultimate anatomic success rates (95% vs. 91% and 100% in both groups, respectively) and the mean visual acuity changes did not differ significantly between groups; the surgical time and intraoperative bleeding in the IVB/MIVS group decreased significantly compared with the 20-g PPV group (P<0.001). The rate of visual improvement of 3 lines or more at the 6-month follow-up was 68% in the IVB/MIVS group and 49% in the 20-g PPV group, respectively. Progression of the preexisting TRD after IVB occurred in 7 eyes (18%). Absence of previous laser photocoagulation (P = 0.025) and the presence of a ring-shaped fibrovascular membrane (P = 0.013) were relevant findings in eyes with these IVB-induced complications. Intravitreal bevacizumab plus MIVS offers comparable anatomic success compared with conventional 20-gauge PPV in patients with TRD resulting from severe PDR. This technique shortens the surgical time with fewer intraoperative complications and favorable visual recovery. However, caution should be taken because of rapid progression of the preexisting TRD after IVB in some patients. The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Experimental and clinical studies of transconjunctival vitrectomy 20G, 23G and 25G

Abstract Purpose Microincision transconjunctival vitrectomy has gained popularity in the recent years. This surgical innovation needs to be evaluated in prospective and controlled studies. Methods A prospective study concerning 23‐Gauge vitrectomy (with cryoapplication and gas tamponade) in 20 patients with retinal detachment and 4 patients with acute endophthalmitis was performed and litterature data (Pubmed database research) was analyzed. Results Performance of microincision transconjunctival vitrectomy may be maximized with use of high duty cycle, largest internal diameter (23G), a sharp guillotine and a high cut rate. Sclerotomy construction is a key point of this technique. In retinal detachment surgery on a selected population, the rate of anatomic reattachment and visual recovery were similar between 23G PPV and 20G PPV. In one patient 23G PPV was complicated by a choroidal detachment secondary to a displacement of the infusion cannula. The redetachment in one 23G case was secondary to a sclerotomy related retinal tear. Microincision transconjunctival vitrectomy for acute endophthalmitis is feasible but has limited capacities as compared with 20G technique. Conclusion The main advantage of sutureless vitrectomy remains the confort of patient after complicated surgeries, but this point should be analyzed with quality of life. This trend toward smaller incisions will lead to improvement of instrumentations, better understanding of the surgical techniques (wound construction, performance of vitreous cutters). 23G PPV is suitable for patients with retinal detachment treated with PPV‐cryo‐gas technique. Sutureless vitrectomy is usefull only in selected cases of acute endophthalmitis .