23-gauge Surgery Research Articles

TRANSCONJUNCTIVAL 25-GAUGE SUTURELESS VITRECTOMY AND SILICONE OIL INJECTION IN DIABETIC TRACTIONAL RETINAL DETACHMENT

The purpose of this article was to evaluate the outcomes and complications of transconjunctival sutureless 25-gauge vitrectomy using silicone oil tamponade in diabetic tractional retinal detachment. Patients were retrospectively evaluated. Main outcome measure was the feasibility of pars plana vitrectomy and silicone oil injection with 25-gauge system in eyes with diabetic tractional retinal detachment. Fourteen eyes of 14 patients were included in the study. Tractional retinal detachment was accompanied by vitreous hemorrhage in 9 eyes and combined traction/rhegmatogenous retinal detachment was present in 1 eye. All patients underwent transconjunctival sutureless 25-gauge vitrectomy and 1,000 centistokes silicone oil injection. Angled insertion of the trocars was made in all eyes. Bimanual surgery was performed in 6 (42.8%) eyes. The median preoperative best-corrected visual acuities were 3.00 logarithm of the minimum angle of resolution; it increased to 1.60 logarithm of the minimum angle of resolution at last visit. Retinal tear formation occurred in 4 (28.5%) eyes. Retinal detachment developed in 2 (14.2%) eyes. Intraocular pressure of 5 mmHg or less was detected in 3 (21.4%) eyes. One patient lost light perception due to anterior hyaloidal fibrovascular proliferation. Pars plana vitrectomy and 1,000 centistokes silicone oil injection with 25-gauge system is feasible in diabetic tractional retinal detachment even in complex cases. Indications of 25-gauge surgery may be expanded toward this area.

The incidence of endophthalmitis following transconjunctival sutureless 25- vs 20-gauge vitrectomy

To determine the incidence of endophthalmitis following 25-gauge and standard 20-gauge vitrectomy. In this single-centre retrospective interventional case series, we evaluated the incidence of acute endophthalmitis occurring within the 14-day postoperative period in all patients who underwent pars plana vitrectomy between 1 November 2002 and 31 December 2006. A total of 3477 consecutive patients were identified. Of them, 3046 patients underwent 20-gauge vitrectomy and 431 underwent 25-gauge vitrectomy. The event rates of postoperative endophthalmitis were 0.03% (1 of 3046) after 20-gauge vitrectomy and 0.23% (1 of 431) after 25-gauge vitrectomy (P=0.23). In the endophthalmitis case that occurred after 25-gauge vitrectomy, a combined phacoemulsification cataract surgery was performed with the 25-gauge vitrectomy. Analyses of event rates of postoperative endophthalmitis after combining phacoemulsification cataract surgery and vitrectomy were 0% (0 of 170) for 20-gauge vitrectomy and 2.17% (1 of 46) for 25-gauge surgery vitrectomy (P=0.21). The incidence of postoperative endophthalmitis following 25-gauge vitrectomy and 20-gauge surgery is low. Although there is a trend suggesting an increased risk of endophthalmitis with the 25-gauge system, this difference was not statistically significant given the low number of measured outcomes.

VISUAL OUTCOMES WITH 23-GAUGE TRANSCONJUNCTIVAL SUTURELESS VITRECTOMY

To evaluate the outcomes of patients treated with 23-gauge transconjunctival sutureless vitrectomy for various posterior segment conditions. A retrospective chart review of 81 consecutive 23-gauge vitrectomy cases done by a single vitreoretinal surgeon for various posterior segment conditions was done. All surgery was performed using the two-step 23-gauge system developed by Dutch Ophthalmic Research Center. All patients had at least 3-month follow-up. Main outcome measures included visual acuity, intraocular pressure, and operative complications. Mean follow-up was 6.5 months (range 3-9 months). Mean overall preoperative visual acuity was 20/150 and final acuity was 20/70 (P < 0.0001). Mean intraocular pressure on postoperative day 1 was 14 mmHg (range 6-28 mmHg). There was a single case of intraoperative retinal tear that required treatment with cryotherapy. Twenty eyes of 48 phakic eyes (42%) had worsening of cataracts in the postoperative period. There were no postoperative complications of endophthalmitis or retinal detachment. Twenty-three-gauge transconjunctival sutureless vitrectomy is an effective surgical technique in the management of vitreoretinal diseases. Complications were rare and compared favorably with published literature on 20-gauge and 25-gauge surgery.

UNTOWARD OUTCOMES IN 25-GAUGE VERSUS 20-GAUGE VITREORETINAL SURGERY

This study compares the incidence of complications in eyes undergoing 25-gauge versus 20-gauge vitreoretinal procedures. Retrospective case series. A chart review of consecutive patients who underwent primary 25-gauge (129 eyes) and 20-gauge (129 eyes) vitreoretinal surgery by four surgeons at a single center between September 2002 and November 2005 was conducted. Mean follow-up was 9.1 +/- 4.9 months in 25-gauge eyes and 14.3 +/- 8.4 months in 20-gauge eyes (P < 0.01). Intraoperative complications were mainly rhegmatogenous in nature and occurred at statistically similar incidence (4.7% in 25-gauge eyes, 6.9% in 20-gauge eyes). Postoperative complications that were significantly associated with surgical method included hypotony and serous choroidal effusions (7.9% in 25-gauge eyes, 1.6% in 20-gauge eyes, P = 0.02). Other postoperative complications noted included retinal tears and detachments (5.4% in 25-gauge eyes, 4.7% in 20-gauge eyes), persistent vitreous hemorrhage (5.4% in each group), and new vitreous hemorrhage (3.9% in 25-gauge eyes, 0.8% in 20-gauge eyes). Endophthalmitis was noted only in 25-gauge eyes in 2 cases (1.6%). Cataract progression occurred at similar rates in both groups (46%). 25-gauge surgery is associated with a significantly greater incidence of postoperative serous choroidal effusions and hypotony. Of particular concern in 25-gauge surgery is the increased risk of associated endophthalmitis. Operative indications and case selection may be important in minimizing the tendency toward certain postoperative events.

25-Gauge transconjunctival sutureless vitrectomy

The history and development of 25-gauge transconjunctival sutureless vitrectomy are reviewed in this paper. The expanded spectrum of appropriate cases and recent innovations in vitrectomy surgery are discussed, as are longer-term outcomes and possible complications. 25-Gauge pars plana vitrectomy has evolved significantly since its introduction in 2002, with newer instruments and novel techniques expanding the scope and improving outcomes in vitreoretinal surgery. Proper case selection is imperative, as the smaller scale of the instruments and decreased fluidics work most efficiently when extensive manipulation of intraocular tissue or significant membrane dissection is not required. Unique complications of 25-gauge surgery such as hypotony and a possible increased rate of endophthalmitis may be related to unsutured sclerotomies, and revisions in surgical approach may help to decrease these potentially devastating complications. Clinical experience over the last several years has proven that this sutureless system is both safe and efficacious. Decreased surgical times, reduced postoperative inflammation, and more rapid patient recovery have all contributed to an increased acceptance of 25-gauge vitrectomy by retinal physicians.