25G Transconjunctival Sutureless Vitrectomy Research Articles

Non-perforating Intrascleral Stabbing for Sutureless 23G Sclerotomy Closure.

The need for suturing leaking sclerotomies have not been eliminated completely in transconjunctival sutureless vitrectomy (TSV). This study aims to describe a novel technique for 23 gauge (G) sclerotomy closure in TSV surgery and discuss its effectiveness. Two hundred and thirty cases of 180 patients who underwent 23G TSV with various diagnoses were included to the study. Cases with connective tissue diseases, thin sclera and significant conjunctival and scleral scarring were excluded. Non-perforating intrascleral stabbing (NIS) was performed to leaking 23G sclerotomies (n=650) and 27G chandeliers (n=84). Demographics, rate of sclerotomy closure with NIS procedure, the need for suturing and complications of the procedure were recorded. The overall success of NIS was found to be 91.0% in sclerotomies. While 9.1% of sclerotomies required sutures, 592 of the 650 sclerotomies could be closed with NIS procedure (p<0.001). NIS procedure helped close 98.8% of leaking 27G chandeliers. An average of 1.28+0.52 NIS attempts were needed for succesful sclerotomy closure. Closure of sclerotomies with the NIS technique were somewhat related to the location of the sclerotomy, previous history of TSV and NIS, duration of TSV, and type of endotamponade. Hypotonia and choroidal detachment were seen in 1 case. No additional interventions were needed to normalise intraocular pressure in any case. Subconjunctival hemorrhage happened to be the leading complication of the procedure. NIS procedure seems as a practical, reproducible, cost-effective and uncomplicated approach which significantly reduces the need to suture 23G sclerotomies. Further studies are required.

Visual Outcome after Vitrectomy with Subretinal tPA Injection to Treat Submacular Hemorrhage Secondary to Age-Related Macular Degeneration or Macroaneurysm.

Purpose To determine the efficacy and safety of 23G transconjunctival sutureless vitrectomy, subretinal injection of tissue plasminogen activator using the EVA Surgical System, and pneumatic displacement with air to treat submacular hemorrhages. Methods Retrospective analysis of 93 eyes surgically treated for submacular hemorrhage caused by neovascular AMD or retinal macroaneurysms. Main Outcome Measures. Postoperative visual acuity and surgical complications. Results After surgery, visual acuity improved after 6 weeks but decreased again at the final postoperative visit at 8 months due to progression of the underlying disease. Complications consisted of 2 cases of retinal pigment epithelial tear, 7 vitreous hemorrhages, 4 hyphema, 6 cases of retinal detachment, and 2 subchoroidal hemorrhages during the follow-up period. Conclusions This study suggests that a surgical approach with 23G vitrectomy, subretinal tPA injection, and pneumatic displacement using air may be an effective procedure for submacular hemorrhage displacement in patients with AMD and retinal macroaneurysms. However, visual outcome is limited by the underlying macular pathology. Larger multicenter randomized controlled studies are warranted to determine the therapeutic effect of this surgical approach.

Outcomes of 23-Gauge Transconjunctival Sutureless Vitrectomy in Patients with Diabetic Retinopathy.

Objectives:This study evaluated the anatomical and functional results of 23-G transconjunctival sutureless vitrectomy (TSV) in diabetic retinopathy (DR) patients with a variety of vitreoretinal diseases.Methods:Consecutive patients who underwent 23-G TSV for complications of DR were evaluated retrospectively. The primary outcome measures were best-corrected visual acuity (BCVA), intraocular pressure (IOP), and intraoperative and postoperative complications.Results:A total of 42 eyes of 41 patients were included and followed up for a mean of 15.64±10.0 months. The mean patient age was 59.33±7.4 years. Indications for surgery were nonclearing vitreous hemorrhage (VH) (n=10), tractional retinal detachment (TRD) (n=8), TRD+VH (n=12), epiretinal membrane (n=5), diabetic macular edema (n=3), submacular hemorrhage (n=2), macular hole (n=1), or vitreomacular traction (n=1). There was a significant improvement in the BCVA at the postoperative first and third months, and at the last visit compared with the preoperative value (p<0.001). There was no significant change in the mean IOP measured on the postoperative first day, first week, first month, third month, or the last visit (p>0.05). In the postoperative period, the VH resolved spontaneously in 9 eyes. Repeat 23-G vitrectomy was performed in 6 eyes: 4 with recurrent retinal detachment and 2 with VH.Conclusion:The results indicate that 23-G TSV is an effective technique for vitreoretinal disease in patients with DR.

One-year outcomes of 27-gauge versus 25-gauge pars plana vitrectomy for uncomplicated rhegmatogenous retinal detachment repair

Background27-gauge (27G) and 25-gauge (25G) transconjunctival sutureless vitrectomy (TSV) were considered equal about safety, effectiveness and vitrectomy time for the treatment of rhegmatogenous retinal detachment (RRD), although larger and long-term comparative studies are needed to confirm previous knowledge. Furthermore, a combined comparison of time duration of surgery and vitreous removal was never performed. Our purpose was to compare the safety and efficacy of 27G versus 25G TSV for the treatment of uncomplicated RRD over a 1-year follow-up.MethodsA 12-months single-center prospective, randomized, interventional study of 92 consecutive patients was performed. 46 patients underwent 27G TSV (Group 1) and 46 underwent 25G TSV (Group 2). Primary outcomes were primary and final reattachment rate, and final functional success (visual acuity ≥ 20/200, 1 LogMar). Secondary outcomes were the surgical and vitrectomy time. Complications were recorded.ResultsAll functional and morphologic data at baseline and at all follow-up time points up to 12 months after surgery were available for only 88 patients. Four patients in Group 1 dropped out of the study after surgery. There was no significant difference in baseline characteristics between the two groups. Primary and final reattachment rates were 90.5% and 100% in Group 1, and 95.6% and 100% in Group 2, respectively (p > .05, p > .05, respectively). Visual acuity improved from 1.5 ± 1.09 LogMar to 0.38 ± 0.55 LogMar in Group 1 (p < .001) and 1.2 ± 0.9 LogMar to 0.49 ± 0.53 LogMar in Group 2 (p < .001), without significant difference between the groups (p > .05). The surgical time was 73.2 ± 11.3 min with 27G TSV and 64.4 ± 9.5 min with 25G TSV (p = .0001). The vitrectomy time was 19.9 ± 3.8 min with 27G TSV and 20.8 ± 3.8 min with 25G TSV (p > .05). One single case of choroidal detachment occurred.ConclusionsReattachment rates, functional success and vitrectomy time were comparable between 27G and 25G TSV for RRD. Surgical time was significantly longer using 27G vitrectomy.

Clinical study of razumab combined with 25G transconjunctival sutureless vitrectomy in the treatment of 29 patients with idiopathic macular anterior membrane

Objective To investigate the effect of razumab combined with 25 G transconjunctival sutureless vitrectomy in patients with idiopathic macular epiretinal membrane (IMEM). Methods 57 cases (57 eyes) of IMEM patients in our hospital were divided into two groups according to random number table. 28 cases in the control group were treated with 25G transconjunctival sutureless vitrectomy, and 29 cases in the observation group were treated with rezumab on the basis of the control group.The improvement of visual acuity, changes of macular fovea thickness (central foveal thickness, CFT), serum levels of vascular endothelial growth factor (VEGF) and intercellular adhesion molecule-1 (ICAM-1) in the two groups were observed and compared. The changes of intraocular pressure before treatment and at different time points (1 weeks, 1 months, 3 months) after treatment and incidence of complications in two groups were statistically analyzed. Results 3 months after treatment, the improvement rate of visual acuity in the observation group was 75.86% (22/29), higher than that in the control group 50% (14/28) (P 0.05). The incidence of complications in the observation group was 10.34% (3/29), while that in the control group was 7.14% (2/28), with no significant difference between the two groups (P>0.05). Conclusions The combination of rezumab and 25G transconjunctival sutureless vitrectomy can reduce the CFT of IMEM patients, improve their levels of serum ICAM-1 and VEGF, and improve their vision. Besides, it has little influence on intraocular pressure and fewer complications. Key words: Ranibizumab; Conjunctiva; Vitrectomy; Macula lutea; Retina

Comparison between 20-, 23-, and 25-G transconjunctival sutureless vitrectomy in the surgical treatment of idiopathic macular hole and idiopathic epiretinal membrane

Aim The aim of the present study was to compare 20, 23, and 25-G transconjunctival sutureless vitrectomy (TSV) systems in the management of idiopathic macular hole and idiopathic epiretinal membrane (EMM) as regards the operative time and postoperative complications such as hypotony (as shown by intraocular pressure Patients and methods This prospective, comparative, randomized clinical study was carried out on 60 consecutive patients undergoing TSV at a single center and by the same surgeon. Included patients were with preoperative diagnoses of idiopathic macular hole (group A) and idiopathic EMM (group B). Ten patients of each group were randomly allocated to 25-, 23-, or 20-G TSV subgroups using a table of random numbers. Three-port pars plana vitrectomy with internal limiting membrane peeling in group A with gas tamponade and EMM peeling in group B was carried out. Results In group A, the mean duration of surgery in the 20-G TSV subgroup was 43.7 ± 1.89 min compared with 42.5 ± 2.01 min in the 23-G subgroup and 43.5 ± 1.84 min in the 25-G subgroup. There was no statistically significant difference between the three subgroups. In group B, there was no statistically significant difference between the three subgroups, with a mean time of surgery of 35.8 ± 1.81 min in the 20-G subgroup versus a mean time of 37.9 ± 2.33 and 37.3 ± 1.98 min in the 23-G and the 25-G subgroups, respectively. In group A, the intraocular pressure was within the normal range in all follow-up periods in the three subgroups and no reported cases of hypotony either in the early or late follow-up periods. In group B, there was a statistically significant difference only in the first follow-up period between the three subgroups, as two cases of hypotony in the 20-G subgroup and two cases in the 25-G subgroup were reported, all of which resolved without sequelae. There were no cases of postoperative endophthalmitis in any case of either group A or group B. There were no cases of postoperative retinal detachment in any case of either group A or group B in all follow-up periods. Conclusion The current study indicated no increased risk of postoperative complications such as hypotony, endophthalmitis, or retinal detachment during sutureless vitrectomy.

23-Gauge versus 25-Gauge Vitrectomy for Proliferative Diabetic Retinopathy: A Comparison of Surgical Outcomes

Purpose: This study compared clinical outcomes and complications between 23-gauge (23g) and 25-gauge (25g) transconjunctival sutureless vitrectomy in patients with proliferative diabetic retinopathy. Study Design: It was a retrospective study using data prospectively defined and collected. 80 eyes underwent 23g transconjunctival sutureless vitrectomy, and 80 eyes underwent 25g surgery using the same vitrectomy system by one surgeon. Primary outcome measures were best-corrected visual acuity, intraocular pressure (IOP), and incidence of intraoperative and postoperative complications. Results: Vision was significantly improved after intervention in both groups (p ≥ 0.0001). There was no significant difference in visual outcomes between the groups (p = 0.43) or in the type and frequency of retinal breaks occurring during surgery (p = 0.63). The 23g group had significantly more patients with a day 1 IOP of <6 mm Hg (p = 0.034) and significantly more patients requiring a sclerostomy suture postoperatively (p = 0.014). Conclusion and Message: Both gauges are equally effective for the treatment of proliferative diabetic retinopathy.

Clinical research of silicone oil removal with a 23-Gauge vitrectomy system

Objective To investigate the effects of Oxane 5700 silicon oil removal with 23G transconjunctival sutureless vitrectomy system(23G TSV).Methods Sixty-eight eyes of 68 consecutive patients undergoing Oxane 5700 silicone removal were collected,and were divided into 23G minimally invasive group (35 eyes)and 20G traditional group(33 eyes).Results The silicone oil was removed successfully in all patients,the mean duration of follow-up was (5.61 ± 1.24) months.There were significant differences between 23G minimally invasive group and 20G traditional group in the mean operation time (t =21.582,P =0.000).There were also significant differences between two groups in the wound opening time and closing time (t =28.681,t =29.720,P =0.000).The best corrected visual acuity in 23 G minimally invasive group was better than that in 20G traditional group at one day after surgery,there was significant differences between two groups(F =6.087,P ＜ 0.05).The intraocular pressure (IOP) at one day after surgery in both groups was lower than that of preoperative,there were significant differences between two groups (F =6.087,P ＜ 0.05).During the operation and follow-up,there was significant differences between two groups in the median of days discomfort and conjunctival congestion of the eye(Z =-2.253,-3.628,P ＜0.05).Conclusion The 23G TSV is a safe and effective surgical technique to remove Oxane 5700 silicone oil.Compared with traditional standard 20-gauge vitrectomy system surgery,it is time-saving with less red-eye appearance look and high degree of comfort. Key words: Vitrectomy, system, 23-Gauge; Removal, Oxane 5700, silicone oil

Anatomic and Functional Outcome of Triamcinolone-assisted 23-gauge Vitrectomy in Vitreomacular Traction Syndrome

Purpose: To evaluate the outcomes of patients with vitreomacular traction syndrome (VMT) treated with triamcinolone acetonid (TA) assisted 23-gauge (23-G) transconjunctival sutureless vitrectomy.Methods: Restrospective, case series. The medical charts of 13 eyes of 13 consecutive patients with VMT who underwent 23-gauge transconjunctival pars plana vitrectomy were reviewed. All patients had at least six-month follow-up. The main outcome parameters were changes in best corrected visual acuity (BCVA) and central macular thickness (CMT) between the baseline and postoperative follow- up examinations performed at the first, third, and sixth months after the surgery.Results: The mean follow-up period was 7 (range 6–15) months. The mean preoperative BCVA was 1.3±0.4 (logmar). The final BCVA was 0.5±0.3 (logmar) (p = 0.001). The mean CMT was 429±85 µm at baseline, which was significantly reduced to 255±47 µm at the final follow-up visit (p = 0.001). The mean CMT reduction was 174±101 (range: 32–348) µm. No postoperative complications were seen such as endophthalmitis, retinal detachment, hypotony, or glaucoma.Conclusion: Triamcinolone assisted 23-G transconjunctival sutureless vitrectomy is an effective and safe surgical technique in the management of VMT syndrome. Further studies with large case series are needed.

Primary 23-gauge vitreoretinal surgery for rhegmatogenous retinal detachment.

To report the effectiveness and safety of primary 23-Gauge (G) vitreoretinal surgery for rhegmatogenous retinal detachment (RRD). In this retrospective study, 49 eyes of 49 consecutive patients who underwent primary 23-G transconjunctival sutureless vitrectomy (TSV) for RRD between January 2007 and July 2009 at our institution were evaluated. Mean follow-up time was 8.9±7.7 months (1-28 months). Retinal reattachment was achieved with a single operation in 47(95.9%) of 49 eyes. In two eyes (4.1%), retinal redetachment due to new breaks was successfully treated with reoperation using the 23-G TSV system. Mean logMAR visual acuity was 2.01±0.47 preoperatively and 1.3±0.5 postoperatively (P<0.001, Paired t-test). Mean preoperative intraocular pressure (IOP) was 14.1±2.8mmHg. Mean postoperative IOP was 12.3±3.6mmHg at 1 day, 13.1±2.1mmHg at 1 week, 14.3±2.2mmHg at 1 month. Iatrogenic peripheral retinal break was observed in 1 eye (2.0%) intraoperatively. No sutures were required to close the scleral or conjunctival openings, and no eyes required convertion of surgery to 20-G vitrectomy. Primary 23-G TSV system was observed to be effective and safe in the treatment of RRD.

23-GAUGE TRANSCONJUNCTIVAL SUTURELESS VITRECTOMY FOR RETAINED LENS FRAGMENTS AFTER COMPLICATED CATARACT SURGERY

The purpose of this study was to evaluate the effectiveness and safety of 23-gauge (23-G) transconjunctival sutureless vitrectomy in patients with retained lens fragments after complicated cataract surgery. In this retrospective consecutive case series, 17 eyes of 17 patients with retained lens fragments after complicated cataract surgery and managed by using 23-G transconjunctival sutureless vitrectomy were evaluated between January 2007 and March 2009 at our institution. Mean follow-up time was 8.5 ± 3.00 months. Nine patients (53%) were pseudophakic, and 8 (47%) were aphakic. A foldable acrylic intraocular lens was implanted in eight eyes with aphakia. In 2 eyes (11.8%), one of 23-G sclerotomy port was enlarged and intravitreal phacoemulsification was performed with 20-gauge phacofragmatome to remove hard nucleus. Visual acuity improved in 100% of eyes and was 20/40 or better in 70.6% of eyes. Postoperative complications were transient elevation of intraocular pressure (29.4%), decentralization of the intraocular lens (5.9%), fibrin reaction (5.9%), mild vitreous hemorrhage (5.9%), and macular retinal pigment epithelial changes (5.9%). Twenty-three-gauge transconjunctival sutureless vitrectomy was observed to be effective and safe in patients with retained lens fragments after complicated cataract surgery. In cases with hard nucleus, 23-G vitrectomy probe may not be adequate to remove the lens fragments.

Influence of vitrectomy for corneal thickness in diaebetic retinopathy eyes with Pentacam

Background The research of corneal thickness after pars plana vitrectomy in DM patient plays an important role not only theoretically but clinically. Objective Present study was to evaluate the change in corneal thickness after pars plana vitrectomy. Methods A prospective coherent study was designed.Seventy-five eyes of 70 consecutive diabetic retinopathy(DR) patients were collected in Tianjin Medical University Eye Center.Pentacam was used to assess the central and periphery corneal thickness by the same investigator preoperatively and 7 days,1 and 3 months postoperatively,respectively.The thickness values from five corneal zone were obtained,including cornea vertex,the thinnest point of the cornea,periphery cornea near the scleral incision of 4 mm away to vertex of cornea on vertical and 240°,120°,60° meridian ( right eye) or 300°,120°,60° meidian ( left eye ).These results were compared and analyzed with ANOVA of repeated measurement data.Subgroup analysis was performed to evaluate the influence of different corneal positions,the use of conventional 20g or 23g transconjunctival sutureless vitrectomy(TSV) groups,surgery duration,gas or fluid endotamponde on corneal thickness.This study was approved by Ethic Committee of this hospital.Written informed consent was obtained from the subjects before any relative medical procedure. Results The mean corneal thickness was ( 639.9 ± 103.1 ),( 689.5 ± 119.3 ),( 666.5 ±113.7),( 650.8 ± 108.6 ) μm before operation,postperative 7 days,1 and 3 months respectively.As covariates appearing in the model,the corneal thickness change rates were revised as the parameters as following: diabeitc duration =13.0 and age =57.2.The revised corneal thickness was significant different among various time points( F=210.928,P=0.000) and different corneal zones(F=24.843,P=0.000) with the size order in turn P4＞P3＞P1＞P2＞P5.The corneal thickness change rates were less in 23g TSV group compared with conventional 20-g group (F =53.843,P =0.000) and BSS tamponade group compared with gas tamponade group ( F =5.288,P =0.022).But no significant difference was found in the revised corneal thickness among surgery duration ＜ 1 hour group,1-2 hour group and ＞2 hour group( F=1.233,P =0.293). Conclusions Vitrectomy is a safe procedure on the ground of cornea,but TSV and fluid endotamponade appear to be more beneficial to the protection of cornea.Pentacam could offer the reliable data in not only central cornea but also periphery cornea. Key words: Corneal thickness/center, periphery; Transconjunctival sutureless vitrectomy; Diabetic retinopathy

Corneal topographic changes after transconjunctival 23-gauge sutureless vitrectomy

To evaluate the topographic changes of cornea after pars plana vitrectomy (PPV) with the 23-gauge- (23-G) transconjunctival sutureless vitrectomy (TSV) system within the first postoperative month. In this prospective study, corneal topographic changes were evaluated in 24 eyes of 24 patients who underwent PPV with the 23-G TSV system. All eyes underwent computer-assisted videokeratography using NAVIS (Nidek Advanced Vision Information System) software preoperatively and at the first day, first week, and first month postoperatively. The topographic parameters that were analyzed statistically were the average corneal power (ACP), corneal surface cylinder (CSC), surface asymmetry index (SAI), and surface regularity index (SRI). Mean induced astigmatism was estimated by vector analysis software. The Wilcoxon test was used for statistical analysis. Mean ACP was 43.12±1.16 diopters (D) preoperatively and 42.88±1.44 D at first day (P=0.301), 43.04±1.14 D at first week (P=0.796), and 43.32±1.17 D at first month postoperatively (P=0.187). Mean CSC was 0.61±0.32 D preoperatively and 0.71±0.48 D at first day (P=0.918), 0.60±0.25 D at first week (P=0.826), and 0.70±0.33 D at first month postoperatively (P=0.414). Mean SAI was 0.12±0.05 preoperatively and 0.21±0.16 at first day (P=0.070), 0.15±0.06 at first week (P=0.176), and 0.16±0.09 at first month postoperatively (P=0.198). Mean SRI was 0.41±0.37 preoperatively and 1.05±0.41 at first day (P=0.001), 0.54±0.42 at first week (P=0.211), and 0.41±0.5 at first month postoperatively (P=0.861). Mean surgically induced astigmatism was 0.67±0.7 D at first day, 0.36±0.2 D at first week, and 0.33±0.17 D at first month postoperatively. Corneal surface and astigmatic changes were observed to be insignificant in the early postoperative period after PPV with the 23-G TSV system.

Experimental Model to Evaluate Mechanical Closure Resistance of Sutureless Vitrectomy Sclerotomies Using Pig Eyes

The purpose of this study was to report a novel model for comparing mechanical resistance to intraocular pressure (IOP) increases with 23-gauge (23G) and 25G transconjunctival sutureless vitrectomy (TSV) sclerotomies in the immediate postoperative period using an experimental model of a vitrectomized eye. This was a prospective, experimental, randomized, and observer-masked experimental study in which TSV 23G and 25G oblique sclerotomies, performed in same cadaveric pig eye, were subject to an increase in IOP. Mechanical resistance was determined by the resistance to intraocular fluid leak through the sclerotomy. The simultaneous use of the different sclerotomy diameters in the same eye avoided interindividual scleral resistance differences. This animal model allowed comparison of the effect of different sclerotomy diameters (23G and 25G) on incisional mechanical resistance. One hundred twenty eyes were included. In 60.7% of cases, the 23G sclerotomy first allowed intraocular fluid escape (leaked; P = 0.02). When comparing opening pressure values, 23G sclerotomies leaked at significantly lower pressure levels than 25G sclerotomies (P < 0.0001); 53% of the 25G incisions but only 16% of 23G incisions opened at pressure levels greater than 120 mm Hg. Oblique 23G sutureless sclerotomies offer less mechanical resistance to increases in IOP than do 25G sclerotomies. This animal model may become the basis for future studies to evaluate the advantages of using other types of incision or other surgical tools on sclerotomy closure capacity.

Fixating Dislocated Intraocular Lens by 25-Gauge Vitrectomy

To describe a technique for suturing a dislocated intraocular lens (IOL) with 25-gauge (G) instruments. Non-comparative interventional case series performed at a single center. Five patients with a dislocated IOL underwent 25-G transconjunctival sutureless vitrectomy (25G-TSV) with a temporary externalization of the haptics to fixate the IOL. Three IOLs enclosed in the lens capsule were dislocated into the vitreous and removed from the capsule with 25G-TSV using perfluorocarbon liquid. The best-corrected visual acuity and surgical complications resulting from this technique were recorded. In all cases, the IOL was fixed stably and remained well positioned. The visual acuity was improved or maintained in all cases. There were no intraoperative or postoperative complications except for one eye with a postoperative iris capture of the sutured IOL. Findings indicate that 25G-TSV is a practical and safe method for fixating a dislocated IOL.

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.

Visual outcome and complications of 25-gauge vitrectomy for rhegmatogenous retinal detachment; 84 consecutive cases

To assess the visual outcome and complications of 25-G transconjunctival sutureless vitrectomy (25G-TSV) for rhegmatogenous retinal detachments. Retrospective, consecutive, interventional case series of 84 eyes of 84 consecutive patients with RRD who underwent 25G-TSV. All surgeries were performed by a single surgeon at a single centre. The initial and final reattachment rates were 95.2 and 100%, respectively. The mean visual acuity improved from 0.78 logarithm of the minimum angle of resolution (logMAR) units to 0.17 logMAR units at the final examination (P<0.001). A macula-off RRD was present preoperatively in 45 of the 84 eyes, and 11 of these eyes (24.4%) developed postoperative retinal complications. Of these complications, one eye had an intraoperative choroidal detachment, five developed a postoperative macular pucker, one eye had a postoperative macular hole, and four eyes developed a retinal redetachment. The percentages of eyes developing retinal complications in the macula-on group (2.6%) was significantly lower than that in the macula-off group (P=0.004). An intraocular pressure (IOP)>or=35 mm Hg was detected in five eyes (6.0%) within the first postoperative week. All of these eyes had a macula-off RRD, and none of the eyes with a macula-on RRD had an elevation of the IOP (P=0.04). Our findings indicate that 25G-TSV is a feasible treatment for RRD and leads to retinal reattachment rates comparable with those following conventional vitrectomy. However, intra- and postoperative retinal complications and postoperative elevation of the IOP can occur especially in eyes with a preoperative macula-off RRD.

Transconjunctival Sutureless 25-Gauge Versus 20-Gauge Standard Vitrectomy: Correlation Between Corneal Topography and Ultrasound Biomicroscopy Measurements of Sclerotomy Sites

To determine the correlation between corneal shape changes and ultrasound biomicroscopy (UBM) findings at the sclerotomy sites in conventional 20-gauge (G) pars plana vitrectomy (PPV) and 25-G transconjunctival sutureless vitrectomy (TSV) and to compare the effectiveness of the two surgical methods. Prospective, comparative, observational case series. Sixty consecutive eyes (60 patients) undergoing primary 3-port PPV. Thirty eyes (30 patients, group 20-G) were treated with 20-G standard PPV and 30 eyes (30 patients, group 25-G) with 25-G TSV. We compared healing of the sclerotomy sites in the two groups. We determined the correlation between corneal shape changes (surgically induced astigmatism) measured by video keratography and the durations of scleral healing cicatrization by UBM within each group. UBM examination showed that the 20-G sclerotomy sites took about 8 weeks to heal, measured as complete opposition, whereas healing of the 25-G TSV sclerotomy was quite rapid, with complete scleral opposition in about 4 weeks. Corneal topography analysis showed, during the early postoperative period, a surgically induced steepening of the cornea in both groups (20 G, 3.08 +/- 0.56 diopters and 25 G, 0.805 +/- 0.61 diopters, P < 0.001, Mann-Whitney test), which then decreased gradually, recovering to the preoperative level within two months in group 20 G (P > 0.05) and 1 month in group 25 G (P > 0.05). We found a strong statistical correlation between the mean surgically induced keratometric astigmatism and the mean UBM measures of scleral healing (r = 0.99 for group 20 G and r = 0.97 for group 25 G). After PPV, astigmatic changes are especially significant in the early postoperative period in 20-G group; the 25-G TSV system results in faster reduction of surgically induced keratometric astigmatism because of rapid cicatrization of the sclerotomy sites.

SILICONE OIL TAMPONADE IN 23-GAUGE TRANSCONJUNCTIVAL SUTURELESS VITRECTOMY

To describe 20 consecutive patients treated with 23-gauge transconjunctival sutureless vitrectomy and silicone oil tamponade for retinal detachments (RD) of different etiologies. Prospective case series. Twenty patients with complex retinal detachment were submitted to a primary 23-gauge transconjunctival pars plana vitrectomy: rhegmatogenous retinal detachment with proliferative vitreoretinopathy (RRD + PVR) in 7 cases, diabetic tractional retinal detachment (DTRD) in 5 cases, giant retinal tear (GRT) in 2 cases, RRD with multiple tears in 2 cases, GRT + uveitis in 1 case, RRD + uveitis in 1 case, DTRD + RRD in 1 case, and RRD + PVR with intraocular foreign body (IOFB) in 1 case. Length of postoperative follow up ranged from 3 to 14 months. Final visual acuity ranged from 20/25 to hand motion. Postoperatively, none of the 20 eyes had hypotony or leakage of silicone oil through the sclerotomies. Seventeen out of 20 (85%) had improved vision. Silicone oil tamponade was demonstrated to be a feasible option in conjunction with 23-g transconjunctival sutureless vitrectomy to treat complex retinal detachment.