Combined 23-gauge Vitrectomy Research Articles

Fifty Consecutive Cases of Transconjunctival Sutureless 23-Gauge Vitrectomy Combined With Phacoemulsification and IOL Implantation

To evaluate safety and effectiveness of combined 23-gauge vitrectomy and phacoemulsification with intraocular lens (IOL) implantation for eyes with vitreoretinal conditions and progressed cataract. The authors retrospectively reviewed 50 previously nonvitrectomized eyes of 50 patients with various vitreoretinal conditions and cataract affecting visual acuity. They underwent combined surgery with sutureless transconjunctival 23-gauge vitrectomy and phacoemulsification with IOL implantation. Surgical indications were a progressed cataract with various retinal conditions. Best-corrected visual acuity (BCVA) improved from 0.23 (range: 0.125 to 0.32; standard deviation [SD]: 0.08) to 0.48 (range: 0.32 to 0.8; SD: 0.16). Spherical equivalent changed from 0.50 to 0.08 diopters. Cataract surgery mean time was 10.46 minutes, vitrectomy mean opening time was 1.1 minutes, and mean vitrectomy procedure time varied widely depending on the type of retinal surgery (20.06 minutes; range: 5 to 55; SD: 11.10). At 1 week, relative hypotony was found in 12% and hypotony was found in 4%. There was no hypotony 3 months after surgery. Transconjunctival 23-gauge vitrectomy with phacoemulsification with IOL implantation appears effective with an acceptable safety profile for patients with cataract with simultaneous retinal diseases.

23-Gauge Pars Plana Vitrectomy with Pars Plana Baerveldt Tube Placement for Refractory Glaucoma

To describe a case series of combined 23-gauge vitrectomy and pars plana Baerveldt tube insertion for intraocular pressure (IOP) control in eyes with glaucoma resistant to maximum tolerated medical therapy and/or having failed previous IOP-lowering procedures. Eight consecutive patients (8 eyes) undergoing a combined procedure were identified and included in this study. Outcome measures included preoperative and final best-corrected visual acuity (VA), IOP, number of glaucoma medications, and complications. Changes in IOP and glaucoma medications were compared by a paired t test. A Kaplan-Meier survival curve was constructed to evaluate IOP control as a function of time. Mean patient age was 70.9 years while the mean follow-up time was 12.1 months. Open angle glaucoma was diagnosed in 5 (68%) eyes. Six (75%) eyes were pseudophakic. All eyes received a 250-mm(2) pars plana Baerveldt tube. Vision remained the same or improved in 6 (75%) eyes. Mean preoperative IOP and number of glaucoma medications were significantly (p<0.05) reduced by the combined procedure. Visual acuity of 5 (63%) eyes improved or remained unchanged. Six (75%) eyes encountered minor complications not requiring a return to the operating room. One (13%) eye underwent drainage of hemorrhagic choroidals on postoperative day 12. A combined 23-gauge vitrectomy and pars plana Baerveldt tube insertion could be considered a useful procedure in reducing IOP and the number of glaucoma medications in eyes with refractory glaucoma.

Comparison of disposable sutureless silicone ring and traditional metal ring in 23-gauge vitrectomy combined with cataract surgery

Background:The purpose of this prospective, interventional, comparative case series was to evaluate the efficiency and feasibility of a disposable sutureless silicone lens ring for corneal contact lens stabilization during combined 23-gauge vitrectomy and cataract surgery.Methods:We developed a ring consisting of a single silicone component with three footplates along the ring margin to fit cannulae for holding conventional contact lenses. Thirty eyes from 30 patients with cataract and vitreoretinal disease were included, and divided into two matched groups according to disease type and ring used. In Group A, we used a 23-gauge transconjunctival vitrectomy system and a disposable sutureless silicone lens ring (n = 15). In Group B, we used a 23-gauge transconjunctival vitrectomy system and a conventional metal lens ring (n = 15). The main outcome measures were: time required for vitrectomy preparation, rate of intraoperative corneal limbus bleeding, and limbus scar rate at the final follow-up visit.Results:Thirty cases were successfully completed. The average vitrectomy preparation time was less in Group A than in Group B (P < 0.01), and the average preparation time saved was 3.94 minutes. None of the Group A patients had intraoperative bleeding or postoperative scarring, whereas all 15 Group B cases had bleeding and five had scarring. There was a statistically significant difference between Group A and Group B for these complications (P ≤ 0.05).Conclusion:This report demonstrates the advantages of using a sutureless silicone ring during combined 23-gauge vitrectomy and cataract surgery. Using this method could allow extra time for the surgeon to pay more attention to complex vitreoretinal procedures.

MINIMAL FLUID–AIR EXCHANGE IN COMBINED 23-GAUGE SUTURELESS VITRECTOMY, PHACOEMULSIFICATION, AND INTRAOCULAR LENS IMPLANTATION

The purpose of this study was to compare rates of postoperative hypotony and intraocular lens-related complications between minimal fluid-air exchange and partial fluid-air exchange in combined 23-gauge vitrectomy and cataract surgery. A prospective, consecutive, interventional case series of 48 eyes that underwent 23-gauge vitrectomy with a minimal fluid-air exchange (minimal F-A group) was compared with a retrospective, consecutive case series of 38 eyes that underwent 23-gauge vitrectomy with a partial fluid-air exchange (partial F-A group). The main outcome measures were postoperative hypotony (<6 mmHg) and intraocular lens-related complications, such as posterior capsule opacification or pupillary capture. Two (5.3%) of 38 eyes in the partial F-A group had hypotony, and only 1 (2.1%) of 48 eyes in the minimal F-A group had hypotony (P > 0.05). Posterior capsule opacification was identified in 11 (28.9%) of 38 eyes in the partial F-A group but only in 4 (8.3%) of 48 eyes in the minimal F-A group (P = 0.013). Pupillary capture was observed in 3 (7.9%) of 38 eyes in the partial F-A group, but it was absent in the minimal F-A group (P = 0.049). No retinal detachment or endophthalmitis was developed in both groups during follow-up. Minimal fluid-air exchange in combined 23-gauge sutureless vitrectomy and cataract surgery may reduce postoperative hypotony and intraocular lens-related complications.