20G Group Research Articles

Comparison of 27 G Quincke and 25 G Quincke Needles for Post Dural Puncture Headache in Caesarean Section

Introduction: Although modern anaesthesiology has made great progress in the last decades and spinal anaesthesia is popular for its effectiveness, Post Dural Puncture Headache (PDPH) is a significant and well known complication of spinal anaesthesia that may be incapacitating for patients. A few decades ago less refined and thicker spinal needles were being used and the incidence of PDPH was high. But within the last 15 years more refined and thinner needles have been used and the incidence of PDPH is grossly reduced.
 Objective: To compare the incidence and severity of post dural puncture headache using 25 G Quincke and 27 G Quincke needle during spinal anaesthesia in case of caesarean section.
 Materials and Methods: This randomized prospective study was carried out in the Border Guard Hospital, Dhaka, during the period of January to July, 2015. Patients were selected randomly from the age group of 20-35 years having a pregnancy of at least 34 weeks gestation with a single uncompromised fetus and uncomplicated pregnancy. Patients with a history of migraine, convulsion, cerebrovascular accident, Pre-eclampsia, eclampsia, spinal deformity, coagulopathy or previous neurological disease were excluded. They were randomly allocated into two groups. Each group consisting of 50 patients. Data was collected by interviewing and observation results. Data were processed and analyzed by using statistical test.
 Results: There was no statistically significant difference found in age, height, weight and ASA status between two groups. 27G Quincke needle had significantly higher failure rate of successful lumber puncture in first attempt than the 25G Quincke needle (20% vs 6%, P<0.05). There was no difference difference regarding the incidence of intraoperative complications between two groups. The overall incidence of PDPH was 2(4%) in group A and 12 (24%) in group B (P<0.05). Decreased severity of headache was noted in the 27G group Quincke needle. There was no difference regarding the duration of headache in between two groups.
 Conclusion: This study suggests that the risk of PDPH was much lower in 27G Quincke needle as compared to 25G Quincke needle though it had a higher failure rate of successful lumber puncture in first attempt. For spinal anaesthesia 27G Quincke needle should be used.
 Journal of Armed Forces Medical College Bangladesh Vol.12(1) 2016: 17-21

Comparative study of 27-gauge vs 25-gauge vitrectomy for epiretinal membrane

PurposeThe purpose of this study was to compare 27-gauge (27G) with 25-gauge (25G) microincision vitrectomy in patients with epiretinal membrane (ERM).ParticipantsSeventy-four eyes of 66 patients undergoing 3-port pars plana vitrectomy using 27G or 25G instrumentation.MethodsSeventy-four eyes of 66 patients with ERM, who underwent 27G or 25G microincision vitrectomy were prospectively evaluated.ResultsThe mean operation time for vitrectomy was significantly longer in the 27G group than in the 25G group (9.9±3.5 vs 6.2±2.7 min, respectively, P<0.0001). No statistically significant difference was found between the two groups in terms of the mean operation time for ERM–inner limiting membrane peeling (27G vs 25G: 20.2±9.9 vs 16.1±9.3 min, P=0.14), although the time for vitreous cutting was longer in the 27G group (9.9±3.5 vs 6.2±2.7 min, respectively, P<0.0001). The flare value, intraocular pressure (IOP), and rate of hypotony 1 day after surgery did not differ between the 27G and 25G groups (flare value: 18.7 vs 17.2; IOP: 8.8 vs 9.7 mm Hg; rate of hypotony: 30 vs 35%, respectively). There was no significant difference in the surgically induced astigmatism between the two groups in the follow-up period. The mean time required for wound closure did not show a significant difference between the 27G and 25G groups (7.7 vs 8.6 weeks, respectively).ConclusionThe 27G system is as safe and useful for ERM vitrectomy as the 25G system. Based on its potential, further improvement of 27G instruments could result in greater efficiency.

A prospective randomized study comparing 25-G and 22-G needles of a new platform for endoscopic ultrasound-guided fine needle aspiration of solid masses

BackgroundA new needle platform for endoscopic ultrasound-guided fine-needle aspiration biopsy has been developed that allows interchangeability of all needle sizes. AimsTo prospectively compare the efficacy of the new 25-G needles and 22-G needles for obtaining an adequate aspirate of solid masses. MethodsRandomized controlled trial of 144 patients referred for endoscopic ultrasound-guided fine-needle aspiration of solid pancreatic masses, intraparietal tumours, or lymph-nodes, randomized to the 25-G or 22-G needle arms. ResultsAn adequate specimen was obtained from 74.3% of cases. The sample tended to be more adequate in the 25-G compared to the 22-G group (81% vs. 68%; p=0.09). Crossover was required in 14 (19%) and 12 (17%) cases in the 22-G and in the 25-G groups, respectively (p=0.7). The overall rate of adequacy improved from 74% before crossover to 90% after crossover (p<0.01). When comparing the two groups after crossover, the rate of obtaining adequate samples was significantly higher in the 25-G arm than in the 22-G arm (95.8% vs. 86.1%; p=0.03). ConclusionsThe 25-G needle was superior to the 22-G needle for endoscopic ultrasound-guided fine-needle aspiration biopsy. The adequacy and diagnostic accuracy improved after crossover, reaching 90%.

Influence of needle diameter on spinal anaesthesia puncture failures for caesarean section: A prospective, randomised, experimental study

ObjectivesSpinal anaesthesia represents the technique of choice for elective caesarean section. The purpose of this study was to compare the puncture failure rates with 25, 26 or 27gauge (G) pencil-point, Whitacre type (with introducer) needles during spinal anaesthesia for caesarean section. Study designProspective, randomised, experimental study in healthy subjects. Patients and methodsWe recruited 330 adults, consecutively scheduled parturients, randomised into three groups. The subarachnoid puncture procedure was standardised. The flexibility of the three needle types was assessed in vitro, and a force was applied using a dynamometer. The occurrence of postdural puncture headache was also evaluated. ResultsThe number of spinal puncture failures was significantly higher in the 27G group, than in the 25G (P=0.006) group and the 26G (P<0.001) group, but did not differ between the 25G and 26G groups (P=0.606). Ten postdural puncture headaches were observed without significant differences among the groups. ConclusionsThis prospective study showed that puncture failures occur less frequently with the use of 25G or 26G pencil-point needles as compared to 27G needles, probably due to the higher flexibility of the latter. This characteristic was demonstrated in vitro, in a reproducible model. This experiment suggests that a 26G pencil-point needle is the optimal gauge for performing spinal anaesthesia for scheduled caesarean sections.

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.

Three-dimensional arrangement of β-tricalcium phosphate granules evaluated by microcomputed tomography and fractal analysis

The macrophysical properties of granular biomaterials used to fill bone defects have rarely been considered. Granules of a given biomaterial occupy three-dimensional (3-D) space when packed together and create a macroporosity suitable for the invasion of vascular and bone cells. Granules of β-tricalcium phosphate were prepared using polyurethane foam technology and increasing the amount of material powder in the slurry (10, 11, 15, 18, 21 and 25g). After sintering, granules of 1000–2000μm were prepared by sieving. They were analyzed morphologically by scanning electron microscopy and placed in polyethylene test tubes to produce 3-D scaffolds. Microcomputed tomography (microCT) was used to image the scaffolds and to determine porosity and fractal dimension in three dimensions. Two-dimensional sections of the microCT models were binarized and used to compute classical morphometric parameters describing porosity (interconnectivity index, strut analysis and star volumes) and fractal dimensions. In addition, two newly important fractal parameters (lacunarity and succolarity) were measured. Compression analysis of the stacks of granules was done. Porosity decreased as the amount of material in the slurry increased but non-linear relationships were observed between microarchitectural parameters describing the pores and porosity. Lacunarity increased in the series of granules but succolarity (reflecting the penetration of a fluid) was maximal in the 15–18g groups and decreased noticeably in the 25g group. The 3-D arrangement of biomaterial granules studied by these new fractal techniques allows the optimal formulation to be derived based on the lowest amount of material, suitable mechanical resistance during crushing and the creation of large interconnected pores.

Changes in corneal sensation following 20 and 23 G vitrectomy in diabetic and non-diabetic patients.

To evaluate the changes in corneal sensation (CS) following two different port sizes vitrectomy in diabetic and non-diabetic patients. Patients prepared for pars plana vitrectomy were randomly assigned to four groups: diabetics to either 20 G or 23 G and non-diabetics to either 20 G or 23 G vitrectomy systems. CS was measured using the Cochet-Bonnet aesthesiometer at baseline preoperatively, and at 1 day, 1 week, and 1 month postoperative. A total of 40 eyes of 40 patients were included in this study; 20 patients (20 eyes) in each of the 20-G and 23-G groups. The mean age was 55.51±10 years and male/female ratio was 2:3. There were no significant difference between CS at baseline, and at 1 day, 1 week, and 1 month between both the 20-G and 23-G groups. There were significant drops in CSs at 1 day and 1 week for both groups (20 G and 23 G) with incomplete recovery for the 20-G group and complete recovery for the 23-G group. Comparing the two diabetic subgroups (20 G and 23 G) and two non-diabetic subgroups (20 G and 23 G), there were no significant differences in CS between subgroups. Diabetics' eyes had lower CSs throughout the study period in the 20-G and 23-G groups, which was significant at day1 and week 1 postoperatively. The vitrectomy procedure showed reduction in CS in the postoperative period with minimal nonsignificant difference between 20 G and 23 G systems. However, diabetics' eyes showed compromised CS preoperatively and a further significant reduction for 1 month postoperatively compared with non-diabetics.

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

ABG needle study: a randomised control study comparing 23G versus 25G needle success and pain scores

ObjectiveTo determine whether a narrower gauge needle used in ABG sampling is associated with lower pain scores and complication rates without increasing the level of difficulty of the procedure.MethodsWe performed...

Comparison of 23G and 25G + vitrectomy for treatment of proliferative diabetic retinopathy

Objective To compare the outcomes of 23G and 25G plus (25G+) vitrectomy in treatment of proliferative diabetic retinopathy (PDR).Methods This is a prospective randomized study.Fifty-seven PDR patients (75 eyes) with symptoms requiring vitrectomy were randomly divided into 23G vitrectomy group (30 patients,39 eyes) and 25G+ vitrectomy group (27 patients,36 eyes).Visual acuity,intraocular pressures,ophthalmoscopy,B-scan ultrasound was examined before surgery.The follow-up period was 10.0 (23G group) and 8.5 months (25G+ group) respectively.Intraoperative complications,operation time,postoperative visual acuity,intraocular pressure,postoperative complications and postoperative ocular conditions were analyzed.Results The mean surgical times were (53.35± 7.42)minutes and (49.16±5.17) minutes in 23G and 25G+ group respectively,and the difference was significant (t=4.37,P＜0.05).Iatrogenic injuries occurred in 11 eyes (28.21％) and 5 (13.89％) eyes in 23G and 25G + group respectively,and the difference was significant (x2 =4.93,P＜0.05).The postoperative visual acuity of 23G and 25G+ group were improved compared to before surgery (x2=16.81,18.29; P＜0.05).At last follow-up,there was 25 eyes and 24 eyes with visual acuity ≥ 0.05 in 23G and 25G+ groups respectively,and the difference was not significant (x2 =0.13,P＞0.05).Hypotony was detected in 7 and 3 eyes at the third postoperative day in 23G and 25G+ group respectively,and the difference was significant (x2 =5.67,P＜0.05).Conclusion 25G+ vitrectomy is a safe and effective treatment for PDR with shorter surgery time and fewer surgical complications. Key words: Diabetic retinopathy/surgery; Surgical procedures, minimally invasive; Vitrectomy

Intra- and Postoperative Risks and Complications of Small-Gauge (23-G) versus Conventional (20-G) Vitrectomy for Macular Surgery

To compare the complication spectrum and rate of 23-G and 20-G vitrectomy for macular surgery. This was a retrospective comparative analysis of 20-G and 23-G vitrectomy (introduced in 2007) for macular surgery due to macular pucker or macular hole performed between 2006 and 2010 in 61 and 59 eyes, respectively, by 2 experienced surgeons and 2 trainees. We assessed the adjusted hazard ratio for vitrectomy 23-G vs 20-G with a Cox proportional hazard model. We counted retinal detachment, vitreous hemorrhage, endophthalmitis (as early postoperative complications), or cataract progression (as late postoperative complication) as endpoint. We adjusted for indication, surgeon, retinopexy method, and the endotamponade. Follow-up averaged 712 days. Median time to first event was 385 days in the 23-G group and 342 days in the 20-G group. Cox proportional hazard analysis showed no significant difference between vitrectomy 23-G vs 20-G with regard to postoperative complications (hazard ratio 0.79, 95% confidence interval 0.41-1.52). The other covariates did not exert a statistically significant effect on the risk of adverse events. Looking at individual complications, retinal detachment was exclusively found after 20-G. In this homogenous large cohort, we did not find a statistically significant difference in rates of complications between 23-G and 20-G vitrectomy techniques for macular surgery. Trainees performed equally well as experienced surgeons.

Comparative Evaluation of 23- and 25-Gauge Microincision Vitrectomy Surgery in Management of Diabetic Macular Traction Retinal Detachment

To compare the efficacy, outcomes, and complications of 23-G and 25-G microincision vitrectomy surgery (MIVS) in cases of diabetic tractional retinal detachment (TRD). This is a prospective, single-blinded, randomized, comparative study. Fifty eyes of 50 patients with diabetic TRD involving or threatening macula were randomized into 2 groups of 25 each. Group 1 underwent 23-G MIVS and group 2 underwent 25-G MIVS. Patients were followed up at 1 day, 1 week, 1 month, 3 months, 6 months, and 1 year after surgery. The primary outcome measure was anatomic and visual success after surgery. We also compared the 2 alternative MIVS systems and assessed various intraoperative and postoperative parameters. Anatomic achievement was achieved in all eyes and both groups showed a significant improvement in vision after surgery (p = 0.033 and p = 0.004, respectively) and were comparable (p = 0.584). Mean surgical time in 25-G surgery was significantly longer than in 23-G surgery by 4.60 minutes (p<0.001). Postoperative mean astigmatism was comparable in the 2 groups and postoperative hypotony was not encountered in either group. No port-related breaks were seen in either group; however, iatrogenic breaks occurred in 4 eyes in the 23-G group and 5 eyes in the 25-G group (p = 1.000). There was significantly less immediate postoperative pain and foreign body sensation in the 25-G group compared with the 23-G group. Both 23-G and 25-G MIVS have comparable visual and anatomic results for diabetic TRD; however, 25-G surgery may be associated with less postoperative pain and discomfort than 23-G surgery.

A prospective, randomized trial comparing 25-gauge and 22-gauge needles for endoscopic ultrasound-guided fine needle aspiration of pancreatic masses

Objectives. Endoscopic ultrasonography-guided fine needle aspiration (EUS-FNA) is widely performed for pancreatic masses. The 25-gauge needle (25G) might be easier to be manipulated and expected to be associated with fewer complications since it is thinner and more flexible than the 22-gauge needle (22G) although obtaining adequate specimens is questioned. In this randomized trial, the authors tried to compare prospectively 25G and 22G in diagnostic accuracy, manipulability from the operator's viewpoint and procedure-related complications. Material and methods. A total of 188 consecutive patients undergoing EUS-FNA for solid or cystic pancreatic masses were consecutively enrolled and 94 patients were randomized to either 25G or 22G group, respectively. Results. Baseline characteristics were similar except that more masses of 25G group were located in the head or uncinate process of pancreas than those from 22G group. Although there was no difference in diagnostic accuracy (89.4% vs. 88.3% with p = 0.82), 25G was easier to be manipulated (p = 0.004) and related with fewer procedure-related complications (10.6% vs. 3.2% with p = 0.004). Conclusions. 25G can be chosen in preference to 22G when performing pancreatic EUS-FNA because 25G was significantly superior to 22G in terms of manipulability and complications although both were effective for accurate diagnosis.

First report on the use of a thinner 125I radioactive seed within 20-gauge needles for permanent radioactive seed prostate brachytherapy: Evaluation of postimplant dosimetry and acute toxicity

To compare postoperative dosimetry and acute toxicity of new 0.5-mm (125)I seeds in 20-gauge (20G) diameter prostate brachytherapy (PB) needles with standard 0.8-mm seeds in 18G needles. Postoperative dosimetry was performed on 100 consecutive PB patients treated with ThinSeeds in 20G needles and compared with 100 consecutively treated PB patients using standard-sized seeds and needles (18G). Dosimetry was performed on postoperative Day 1 CT scans. Acute urinary retention was also compared between these two groups. Acute toxicity was evaluated in 22 consecutively treated patients with thinner seeds/needles and compared with 22 consecutive concurrent patients treated with standard seeds and needles. All patients were evaluated by pre- and post-PB self-administered surveys, physical examinations on post-PB Day 1, and telephone surveys on Day 7. Endpoints included dysuria, acute urinary retention, hematuria, perineal pain/bruising, and International Prostate Symptom Score. Post-PB dosimetric comparison demonstrated that the V100 (95% vs. 91%), D90 (161Gy vs.149Gy), V150 (55% vs. 45%), and RV100 (0.43cc vs. 0.30cc) were significantly (p<0.0004) higher in the 20G group. Urinary retention rates were 8% and 7% and median catheter-dependent durations were 7 and 14 days for the 20G and 18G groups, respectively. No significant differences were found for dysuria, hematuria, or International Prostate Symptom Score. Post-PB Day 1 perineal bruising and pain scores on Days 1 and 7 were significantly less (p<0.04) in 20G cohort. Smaller diameter needles and seeds resulted in improved post-PB Day 1 V100 and D90 dosimetry, and significantly less acute perineal pain and bruising.

Comparison of the 20-Gauge Conventional Vitrectomy Technique with the 23-Gauge Releasable Suture Vitrectomy Technique

PurposeTo compare the efficacy of the transconjunctival releasable suture technique for pars plana vitrectomy using 23-gauge (23G) instruments versus the conventional 20-gauge (20G) technique.MethodsA retrospective and interventional case series was consecutively performed for 199 eyes of the 192 patients that were a part of this study. Clinical data were reviewed retrospectively regarding the operation time, preoperative and postoperative intraocular pressure, visual acuity and astigmatism for 54 consecutive patients who received a 23G releasable suture vitrectomy and for 98 consecutive patients who received a 20G conventional vitrectomy during the period between April 2007 and September 2010.ResultsMean operation time based on the operation record was 88.5 ± 20.1 minutes in the 23G releasable suture vitrectomy group and 102.1 ± 23.1 minutes in the 20G conventional vitrectomy group, respectively (p = 0.01). The last best-corrected visual acuity (BCVA) was significantly better than the preoperative BCVA in both patient groups (p = 0.01, p = 0.01). The 23G releasable suture group showed less surgically induced astigmatism than the 20G conventional vitrectomy group. Vitreous bleeding was observed to be in 6 eyes (5.9%) in the 23G group, and in 8 eyes (8.2%) in the 20G group. In addition, ocular hypertension was noted to be in 3 eyes (3.0%) in the 23G group, and 6 eyes (6.1%) in the 20G group. No serious complications such as postoperative hypotony or endophthalmitis were observed in either group.ConclusionsThe 23G releasable suture technique is as effective as the 20G conventional technique and offers several advantages.

Clinical presentation of a mixed 23-gauge infusion and 20-gauge pars plana technique for active silicone oil removal.

To present with a clinical case series of a mixed 23-gauge infusion and 20-gauge pars plana technique for 5,700-centipoise silicone oil removal (SOR), and to discuss its efficacy and safety. This is a retrospective, non-randomized controlled study. We performed SOR with 23-gauge infusion and 20-gauge active suction technique on 29 patients 29 eyes from April to October, 2011 (mixed group). During the surgeries, a 23-gauge sclerotomy was made for infusion and a 20-gauge sclerotomy was used for active silicone oil suction. Anterior segment optical coherence tomography (OCT) was applied for 23-gauge sclerotomy analysis 1 day post-operation. Traditional 20-gauge SOR was performed on another consecutive 29 patients 29 eyes, the control group (20G group). There were 2 eyes (6.9%) in mixed group and 5 eyes (17.2%) in 20G group which had recurrent retinal detachment after surgery. Hopytony (IOP≤6mmHg) occurred in 8 eyes (27.6%) of mixed group and in 10 eyes (34.5%) of 20G group post-operation, but all of them recovered to the normal level finally. There were no statistical significant differences. Final visual acuity was significantly increased after surgery in both groups. Anterior segment OCT images were acquired from 13 eyes of mixed group, and all of them had a proper wound apposition. But local ciliary detachment was found in 9 eyes (69%). It was hard to define the OCT image of the sclerotomies and ciliary body because of the serious conjunctival hemorrhages and chemosis in 20G group. This mixed technique is a convenient and effective way to remove high viscosity silicone oil. Compared with traditional 20-gauge SOR, it does not increase the risk of post-operative complications and has less conjunctival reactions.. Transient postoperative hypotony is common for this procedure and subclinical ciliochoroidal detachment is a probable cause.

Results of Penetrating Keratoplasty Triple Procedure With 25-gauge Core Vitrectomy

To report and compare the outcomes of penetrating keratoplasty (PKP) triple procedures [combined PKP, cataract extraction, and intraocular lens (IOL) implantation] with a 25-gauge (G) system, 20-G system, and without core vitrectomy. Subjects comprised the following 3 groups: the 25-G group including 12 eyes of 12 patients (4 men and 8 women) that underwent PKP with 25-G core vitrectomy, the 20-G group including 9 eyes of 9 patients (3 men and 6 women) that underwent PKP with 20-G core vitrectomy, and the non-core vitrectomy group including 9 eyes of 9 patients (1 man and 8 women) that underwent PKP without core vitrectomy. In the 25-G, 20-G, and non-core vitrectomy groups, the success rates of IOL implantation were 91.7% (11 of 12 eyes), 88.9% (8 of 9 eyes), and 66.7% (6 of 9 eyes), respectively; the average operation times were 69 minutes, 82 minutes, and 90 minutes, respectively. The 25-G group showed significantly shorter operation time than the other 2 groups. Although not statistically significant, a higher rate of capsular rupture was seen in the non-core vitrectomy group. A PKP triple procedure with the 25-G system can be a safe treatment that offers a better success rate of IOL implantation and a significantly shorter operation time.

Comparison of 23G and 20G vitrectomy for treatment of infectious endophthalmitis

Objective To compare the outcomes and safety of 23G and 20G vitrectomy for treatment of infectious endophthalmitis.Methods This was a retrospective case study.Sixty-seven eyes of 67 eyes suffering from infectious endophthalmitis with a history of trauma or intraocular operation history were enrolled in this study.They were diagnosed by the examinations of best corrected visual acuity,intraocular pressures,slit lamp microscope,indirect ophthalmoscopy,B-scan ultrasound and CT.There were 49 males (49 eyes) and 18 females (18 eyes).The patients aged from 18 to 72 years with a mean age of (43±13)years.There were 60 patients (60 eyes) with a history of trauma,7 patients (7 eyes) with intraocular operation history.The patients were enrolled into 20G vitrectomy group (35 patients,35 eyes) before December,2009 and 23G vitrectomy group (32 patients,32 eyes) after January,2010 when 23G vitrectomy system was imported in this hospital.Vitreous purulence was taken in all patients at the beginning of the surgery for bacteria and fungal culture and drug sensitivity test. A standard vitrectomy with artificial posterior vitreous detachment followed by internal limiting membrane peeling,and (or) intraocular laser photocoagulation,cryocoagulation,fluid-air exchange with intraocular silicone oil or gas tamponade were performed in all eases.Broad-spectrum antibiotics and glucocorticoids were used systematically for one week after surgery,but glucocorticoids were not used for fungal infections.The follow-up was ranged from two to nine months with a mean of (7 ± 1) months.The surgical time,inflammation situation,visual acuity,intraocular pressure, retinal reattachment rare,iatrogenic retinal hole rate, bulbar conjunctiva scar formation rate,reoperation rate and eye retention situation before and after surgery were comparatively analyzed.Results The mean surgical times were (126 ± 12) and (89 ± 12) minutes in 20G and 23G group,which was significantly different (t=3.125,P＜0.05).The major surgery complications were ora serrata dialysis and other iatrogenic retinal breaks,and were occurred in 34 eyes,including 30 eyes (85.71％) in 20G group and 4 eyes (12.50％) in 23G group (x2 =35.85,P＜0.05).These 4 eyes in 23G group received foreign body removal surgery previously.The inflammation was controlled in 65 eyes (97.01％) including 34 eyes (97.14％) and 31 eyes (96.88％) in 20G and 23G group respectively,which was not significantly different (x2=0.004,P＞0.05).At last follow-up,There was no statistical difference of visual acuity between the two groups (t=3.12,P＞0.05).Fourteen eyes underwent silicone oil tamponade including 13eyes (37.14％) and 1 eye (3.13％) in 20G and 23G group respectively,which was significantly different (x2=11.703,P＜0.05).Nine eyes underwent reoperation (13.43％),including 8 eyes (22.86％) and 1eye (3.13％) in 20G and 23G group respectively,which was significantly different (x2=5.597,P＜0.05).The 8 re-operated eyes in 20G group included 1 eye of recurrent endophthalmitis and 7 eyes with retinal detachment,the 1 re-operated eye in 23G group was of recurrent endophthalmitis.There was significantly different (x2=7.147,P＜0.05) for the rate of retinal detachment between the 2 groups.There were 40eyes with bulbar conjunctiva scar including 35 eyes (100.00％) and five eyes (15.63％) in 20G and 23G group.Conclusion 23G vitrectomy is an effective treatment for infectious endophthalmitis with shorter surgery time,lower reoperation rate,lower retinal reattachment rate and fewer bulbar conjunctiva scar. Key words: Endophthalmitis/surgery; Vitrectomy; Comparative study

Comparison of 23G and 20G vitrectomy for treatment of proliferative diabetic retinopathy

Objective To compare the outcomes of 23G and 20G vitrectomy in treatment of proliferative diabetic retinopathy (PDR).Methods This was a prospective randomized study.One hundred twenty six patients (142 eyes) suffering from PDR with symptoms requiring vitrectomy were randomly divided into 20G vitrectomy group (66 patients,74 eyes) and 23G vitrectomy group (60 patients,68 eyes).Visual acuity,intraocular pressures,indirect ophthalmoscopy,B-scan ultrasound,tear film break up time (BUT),Schirmer I test (S I T),astigmatic power and the astigmatic axial at 6 mm area of anterior and posterior corneal surface were observed and measured before surgery.The follow-up period was 15.0 and 12.5 months separately in 20G and 23G groups.Intraoperative complications,operation time,postoperative visual acuity,intraocular pressure,postoperative complications,re-operation,and postoperative ocular conditions including changes of astigmatic power and the astigmatic axial measurements were analyzed.Results At last follow-up,there was 49 eyes (66.2％) and 47 eyes (69.1％) with visual acuity ≥0.05 in 20G and 23G groups.Comparing visual acuity ≥0.05,there was no statistical difference between the groups (x2=0.14,P＞0.05).The eyes suffering from iatrogenic injuries were 18 (24.3％) and seven (10.3％).There was obvious difference in iatrogenic injury between the two groups (x2=4.81,P＜0.05).The mean surgical times were (69.0±8.2) and (51.0±6.3) minutes in 20G and 23G group,which was significantly different (t=3.65,P＜0.05).The postoperative third day,hypotony was detected in three (4.1％) and 11 eyes (14.7％) in 20G and 23G group,which was a significantly different (x2=5.85,P＜0.05).Postoperatively high intraocular pressures were not significantly different between the two groups (x2=2.54,P＞0.05).There were 24 (32.4％) and 14 eyes (20.6％) in 20G and 23G group.There were significant differences in BUT,S I T,astigmatic power and the astigmatic axial measurements compared with those preoperatively at the first month after operation (t=3.35,4.12,-3.12,-3.22; P＜0.05),but no significant differences in them at the third and sixth month after operation (third month:t =0.45,0.98,-2.12,-1.02; P＞0.05,and the sixth month:t=0.95,1.48,-1.02,-2.11; P＞0.05).In 23G group,there were no significant differences in BUT,S I T,astigmatic power and the astigmatic axial measurements compared with those preoperatively at the first,third and sixth month after operation (first month:t=l.21,1.46,-2.32,-1.61; P＞0.05,third month:t=1.45,2.21,-2.19,-1.89; P＞0.05,and sixth month:t=1.92,1.25,-1.76,-2.35; P＞0.05).Conclusion 23G vitrectomy is a safe and effective treatment for PDR with shorter surgery time,fewer surgical complications and postoperative ocular surface changes. Key words: Diabetic retinopathy/surgery; Vitrectomy; Comparative study

Pars plana vitrectomy for the repair of primary, inferior rhegmatogenous retinal detachment associated to inferior breaks. A comparison of a 25-gauge versus a 20-gauge system

BackgroundTo compare anatomical, functional outcomes and complications of high-speed 25-gauge (G) pars plana vitrectomy (PPV) versus 20-G PPV for the management of primary inferior rhegmatogenous retinal detachment (RRD) associated to inferior breaks/holes.MethodsEighty-five eyes from 85 patients with a minimum follow-up of 3 months were retrospectively evaluated. Forty-one patients underwent 25-G and 44 patients underwent 20-G PPV. All patients underwent PPV with fluid-air exchange, sulfur hexafluoride (SF6) 20 % gas tamponade and laser or cryo retinopexy.ResultsThe mean follow-up interval was 6.51(±2.32) and 6.63 (±2.58) months in the 25-G and 20-G groups respectively. Single-operation success rate was 92.7 % for the 25-G group and 81.8 % for the 20-G group (P = 0.24). Post-operative hypotony was observed in no case. Redetachment occurred in 3 eyes operated on with 25-G and in 8 eyes operated on with 20-G system. All retinas were attached at final follow-up. Logarithm of the minimum angle of resolution visual acuity significantly improved from 0.69 ± 0.76 to 0.33 ± 0.37 in the 25-G and from 0.47 ± 0.59 to 0.21 ± 0.28 in the 20-G group (P = 0.0007 and P < 0.0001 respectively).ConclusionsHigh-speed PPV and SF6 gas tamponade using either 25-G or 20-G PPV system, yields similar single operation anatomical success rates for the repair of uncomplicated, primary inferior RRDs associated to inferior breaks.