Sutureless Vitrectomy Research Articles

Multiple factors in the prediction of risk of recurrent vitreous haemorrhage after sutureless vitrectomy for non-clearing vitreous haemorrhage in patients with diabetic retinopathy

BackgroundWe aimed to analyse multiple factors in the prediction of risk of postoperative recurrent vitreous haemorrhage (RVH) for non-clearing vitreous haemorrhage in patients with diabetic retinopathy (DR) who underwent sutureless vitrectomy with 23- (23G) or 25-gauge (25G) narrow-gauge systems.MethodsA retrospective consecutive case series design was used. DR patients who underwent sutureless vitrectomy for non-clearing vitreous haemorrhage between June 2017 and October 2019 were enrolled. All operations were performed at a tertiary hospital. Patient demographics and risk factors, including age, gender, duration of diabetes, preoperative fasting blood sugar levels (FBSL), systolic blood pressure (SBP), serum creatinine (Cr), urea, triamcinolone acetonide (TA), electrical coagulation, air-fluid exchange, pan-retinal photocoagulation status (PRP), anti-vascular endothelial growth factor drug (anti-VEGF), and other factors, were recorded. Patients were divided into two groups based on the timing of their postoperative RVH: immediate postoperative RVH (within 2 weeks after operation) and delayed postoperative RVH (beyond 2 weeks after operation).ResultsOverall, 167 eyes (167patients) were enrolled. Seventy eyes were underwent 23G and 25G sutureless vitrectomy performed in 97 eyes, respectively. Postoperative RVH developed in 18 eyes (25.7%) in Group 23G and in 20 eyes (21.6%) in Group 25G (P = 0.540). Of these, 3 eyes (4.3%) had severed RVH in Group 23G compared with 5 eyes (5.2%) in Group 25G (P = 0.584). Delayed postoperative RVH occurred in 6 eyes (8.6%) in Group 23G and 8 eyes (8.2%) in Group 25G (P = 0.789). A binomial logistic regression analysis revealed that age, duration of diabetes, and Cr level were significantly associated with RVH in both Group 23G (P < 0.05) and Group 25G (P < 0.05).ConclusionsThe incidence and severity of RVH were 25.7 and 4.3%, respectively, in Group 23G and 21.6 and 5.2%, respectively, in Group 25G. Thus, the 23G sutureless vitrectomy approach was as safe as the 25G sutureless vitrectomy approach for treating vitreous haemorrhage in patients with DR. A younger age, shorter duration of diabetes, and higher Cr levels were risk factors for postoperative RVH in sutureless vitrectomy.

Incidence and risk factors for intraocular pressure rise after transconjunctival vitrectomy.

Purpose:To study the incidence and risk factors of raised intraocular pressures (IOPs) in the follow-up of transconjunctival sutureless vitrectomy (TSV).Methods:A retrospective observational study was performed on 635 patients who underwent TSV under a single surgeon. The IOPs were recorded using a calibrated non-contact tonometer at seven postoperative visits, viz., day 1, 7 and 1, 3, 6 months, and 1 day and 1 month following silicone oil removal.Results:IOP rise was seen in 24.25% (154) out of the 635 eyes studied. Among patients under 50 years of age, 37.73% had an IOP rise, compared to 21.55% above 50 years (Odds Ratio 2.206). Among males, 30.32% had an IOP rise, as compared to 15.98% females (OR 2.287). In eyes with retinal detachment, 49.16% had raised IOP (OR 5.435), and 24.05% with proliferative diabetic retinopathy (OR 1.780), as opposed to 15.38% with macular hole and 12.32% with epiretinal membrane. This was statistically significant (P < 0.001). In eyes with silicone oil, 34.9% developed a rise in IOP (OR 2.738) as compared to 11.94% of other surgeries (OR 0.697). This was statistically significant (P < 0.001).Conclusion:We observed an increase in IOP postoperatively, more in those under 50 years, males and patients undergoing surgery for RD and PDR.

&lt;p&gt;Hybrid 23/27 Gauge Vitrectomy – Combining the Charm of 27G with the Efficacy of 23G&lt;/p&gt;

BackgroundMinimally invasive transconjunctival sutureless vitrectomy (MIVS) has evolved into the standard of care, smaller incisions thought to result in lower ocular surface trauma and shorter times to recovery. The currently most relevant limitations in macular surgery may be light intensity and 27G instrument stability. Therefore, we thought to compare standard 23 and 27G vitrectomy with a hybrid technique using one 23G and two 27G ports regarding surgical times and short-term outcomes.MethodsThis retrospective comparison included 90 single-center consecutive cases of eyes undergoing elective micro-invasive vitrectomy for epiretinal membranes or idiopathic macular holes between October 2017 and June 2018. The main criteria for the comparison were total surgical time as primary outcome parameter and treatment-demanding intra- and postoperative complications along with recovery of best-corrected visual acuity (BCVA) and central retinal thickness (CRT) from prior to surgery to 1 month thereafter as secondary parameters as independent parameters for the recovery from the pre-existing pathology and the surgical trauma.ResultsSurgical times were shorter with 23G and 23/27G compared to 27G (23G: 38.4±13.1; 27G: 48.1±15.3; 23/27G: 34.9±9 mins; p=0.0005) with no differences in BCVA and CRT outcomes. Switching from 27G to a larger port size was not necessary in any instance. Cryotherapy was applied in 15%, 30%, and 22.5% to suspected retinal pathologies, beyond these, in 5%, 0%, and 7.5% for retinal tears. Four postoperative retinal detachments occurred (4.4%), one in the 23G and three in the 23/27G group requiring re-vitrectomy.ConclusionIn this exploratory case series, 23/27G hybrid vitrectomy, combining the advantages of 23G and 27G techniques, resulted in shorter surgical times without evident disadvantages. The combination with cataract surgery was unproblematic.

Evaluation of leakage resistance improvement in transconjunctival sutureless vitrectomy sclerotomies closed with adhesives. an experimental study

BackgroundThe purpose of this paper is to study the utility of adhesives (artificial-cyanoacrylate and biological-fibrin glue) for improving transconjunctival sutureless vitrectomy (TSV) sclerotomy closure competency.MethodsExperimental and observer-masked study in which after performing TSV in cadaveric pig eyes, different adhesives were tested on sclerotomy entrances in order to determine if they improved closure competency in face of progressive intraocular pressure increase. In 76 eyes cyanoacrylate-treated sclerotomies were compared with sclerotomies in which no additional manoeuvre to aid closing was performed; in 76 eyes fibrin glue with no manoeuvre; and in the last 76 eyes, cyanoacrylate-treated sclerotomies were compared with fibrin glue-treated sclerotomies.ResultsA total of 228 eyes had a 23-gauge TSV performed. Both cyanoacrylate and fibrin glue treated sclerotomies achieved higher mean opening pressures when compared with nontreated sclerotomies in the same eye (p < 0.002). When cyanoacrylate was compared with biological adhesive in the same eye, no statistically significant differences were obtained (p = 0.216).DiscussionsThis experimental study provides support for the possible role of adhesives in improving TSV sclerotomy closure competency in clinical practice.

Multicenter survey of sutureless 27-gauge vitrectomy for primary rhegmatogenous retinal detachment: a consecutive series of 410 cases.

To evaluate the surgical outcomes of the 27-gauge (G) vitrectomy system for the treatment of primary rhegmatogenous retinal detachment (RRD). This retrospective consecutive series multicenter study involved a total of 410 eyes of 406 patients who underwent 3-port transconjunctival 27G pars plana vitrectomy (PPV) for RRD between November 2014 and December 2016 and who were followed for a minimum of 3months postoperative. The main outcome measure was primary reattachment, with the secondary outcome measures being final reattachment, improvement of visual acuity (VA), intraocular pressure (IOP), intraoperative and postoperative complications, and surgery time. Of the 410 treated eyes, primary reattachment was achieved in 392 (95.6%) and final reattachment was achieved in 410 (100%). In 226 eyes (55.1%) with macula-on RRD, the mean logarithm of the minimum angle of resolution (logMAR) VA improved from 0.16 ± 0.51 pre-surgery to 0.02 ± 0.14 post-surgery (P = 0.11). In 184 eyes (44.9%) with macula-off RRD, logMAR VA improved from 1.06 ± 0.77 pre-surgery to 0.26 ± 0.35 post-surgery (P < 0.001). Following surgery, the mean IOP was highest at 1day (15.7 ± 7.0mmHg) postoperative. In all eyes, surgery was concluded without the use of sutures or the need of conversion to a larger-gauge instrument. Although hypotony was observed in 14 (3.4%) of the 410 treated eyes at 1day postoperative, it spontaneously resolved within 1week without additional surgical intervention. No postoperative complications such as infectious endophthalmitis were observed throughout the follow-up period. Our findings show that 27G PPV is both safe and effective for the treatment of primary RRD.

Long term results of surgery for idiopathic macular hole

Amaç: İdiopatik makula deliği cerrahisinde 23G sütürsuz vitrektomi ile triamsinolon asetonid kullanılarak iç limitan membran soyulmasını değerlendirmek.Materyal ve Metot: Beyoğlu Göz Eğitim ve Araştırma Hastanesi’nde 2006-2011 yıllarında, makula deliği nedeniyle 23 Gauge pars plana vitrektomi (PPV) ile iç limitan membran (İLM) (triamsinolon asetonid yardımıyla) soyulan ve göz içi gaz tamponadı uygulanan 44 hastanın 49 gözüne ait veriler retrospektif olarak incelendi. Yaş, cinsiyet, makula deliği evresi, en iyi düzeltilmiş görme keskinliği (GK), semptom süresi, cerrahi sonrası fonksiyonel başarı ve optik kohorens tomografi ile anatomik olarak değerlendirildi.Bulgular: Ortalama yaşları 67 ±9,51 olan hastaların 28’i kadın (%57,1) ve 21’i (%42,9) erkekti. Deliklerin 26 tanesi (%53,1) evre 3, 20 tanesi (%40,8) evre 4, 3 tanesi ise (%6,1) evre 2 idi. Hastaların şikayet süresi ortalama 4,14±3,22 ay (1-12 ay) idi. Ortalama 13,81± 9,44 ay (6-58 ay) takip edilen hastaların 44’ünde (%89,8) anatomik başarı elde edildi. Snellen eşeline göre 2 veya daha fazla sıra görme artışı olan hasta oranı %51 (25 göz) oldu. Görme kaybı 6 aydan daha az olan vakaların hem preoperatif en iyi düzeltilmiş GK hem de postoperatif en iyi düzeltilmiş GK’ları daha iyi saptandı. Son vizitteki en iyi düzeltilmiş GK ile deliğin evresi, delik çapı, preoperatif en iyi düzeltilmiş GK ve tamponad çeşiti arasında anlamlı ilişki bulunmadı. Ameliyat sonrası, 33 hastada (%67,3) katarakt, 3 hastada (%6,1) hipotoni gelişti. Sonuç: 23 G sütürsuz PPV ile triamsinolon asetonid kullanılarak İLM soyulması uygulanan idiopatik makula deliği tedavisinin yüksek anatomik ve fonksiyonel başarı ile sonuçlandığı görüldü. Erken dönemde başvuru ve erken cerrahinin sonuç en iyi düzeltilmiş GK’yı etkileyen en önemli faktör olduğu sonucuna varıldı.

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

The Incidence of Retinal Breaks Induced by Posterior Hyaloid Separation During 27-Gauge Pars Plana Vitrectomy

Purpose: As advances are made in smaller-gauge vitrectomy, it is important to characterize the associated risks. This allows the surgeon to anticipate complications and appropriately counsel patients. The incidence of iatrogenic retinal breaks in 25- and 23-gauge (G) vitrectomy is known, but no studies exist looking at the incidence in 27G vitrectomy with an attached posterior hyaloid face (PHF). This study set out to characterize the incidence. Methods: A retrospective, consecutive, observational study of patients undergoing 27G transconjunctival sutureless vitrectomy for macular pathology or floaters was conducted. This was a single-surgeon series conducted between 2015 and 2017 at Calderdale Royal Hospital, United Kingdom. Inclusion criteria included only those with an attached PHF at the disc, identified intraoperatively. Results: Data were collected and analyzed in 94 patients. Preoperative diagnosis frequency was as follows: epiretinal membrane 24 (25.5%), macular hole 47 (50.0%), vitreomacular traction 11 (11.7%), and floaters 12 (12.8%). In 82 out of 94 patients (89.1%), 27G vitrectomy was combined with 2.2 mm microincisional phacoemulsification with lens implantation. The incidence of iatrogenic retinal breaks associated with PHF separation during 27G PPV was 17% (16 cases). Conclusions: This is the first study to report the incidence of peripheral retinal breaks induced by PHF separation during 27G vitrectomy. Our single-surgeon case series of 27G PPV for all elective vitreoretinal indications, in eyes with attached vitreous, yielded an iatrogenic break rate of 17%. However, no postoperative retinal detachments followed. Statistical analysis revealed no specific risk factors to be significantly associated with outcome (incidence of retinal tear).

A Propensity-Score Matching Comparison between 27-Gauge and 25-Gauge Vitrectomy Systems for the Repair of Primary Rhegmatogenous Retinal Detachment.

Purpose To compare the anatomical and visual results and complications of 27-gauge versus 25-gauge transconjunctival sutureless vitrectomy for the management of primary rhegmatogenous retinal detachment. Methods A prospective, propensity score-matched 6-month study was performed. All patients underwent either 27-gauge or 25-gauge vitrectomy as the first surgical intervention and were followed up over a 6-month period, in order to evaluate anatomical success, change in best-corrected visual acuity (BCVA), and intraoperative and postoperative complications including intraocular pressure dysregulation. Results Propensity score matching resulted in two groups of 37 eyes each. All eyes completed a six-month follow-up. Baseline demographic and preoperative ocular characteristics showed no statistically significant difference between the two cohorts. The single operation success rate was 33/37 (89%) for 27-gauge cases and 34/37 (92%) for 25-gauge cases (p=0.7). The final anatomical success rate was 100% for each of the two cohorts. Mean BCVA change at the 6-month postoperative follow-up visit was −0.67 logMAR in the 27-gauge group and −0.71 logMAR in the 25-gauge group (p=0.9). Two patients in the 25-gauge group experienced transient hypotony after surgery. Conclusion No significant difference between 27-gauge and 25-gauge transconjunctival sutureless vitrectomy for the repair of primary rhegmatogenous retinal detachment was recorded in terms of reattachment rate, BCVA, intraoperative and postoperative complications.

Outcomes of 27G(+) transconjunctival sutureless vitrectomy for posterior segment disease

Objective: To report the clinical outcomes and safety profile of 27G(+) transconjunctival sutureless vitrectomy (TSV) in eyes with posterior segment disease. Methods: Prospective, interventional case series. Eyes undergoing 27G(+) TSV for a vitreoretinal surgery indication were included from Dec 2015 to Mar 2016. Change in visual acuity and occurrence of intraoperative and postoperative complications with minimum follow-up of 6 weeks were recorded. Results: Eighty-three eyes met the inclusion criteria. Surgical indications included epiretinal membrane (n=27), proliferative diabetic retinopathy (n=17), full-thickness macular hole (n=11), rhegmatogenous retinal detachment with or without proliferative vitreoretinopathy (PVR) (n=8), vitreous hemorrhage(n=7), vitreous opacities (n=7), diabetic macular edema non-response to anti-VEGF agents(n=4), intraocular lens or cataract nucleus dropped into vitreous cavity (n=2). Mean follow-up was 19 weeks (range 6-34 weeks). Visual acuity improved in all cases. The cutter incarcerated with trocar in a vitreous hemorrhage case. There were no other intraoperative complications and no case required sutured at the conclusion of surgery. Postoperative complications included transient ocular hypertension in 2 eyes (2.4%) and transient hypotony in 1 eye (1.2%). No cases of postoperative endophthalmitis, sclerotomy related retinal tears, or choroidal detachments were encountered in the follow-up period. Conclusion: The 27G(+) TSV was effective and safe for varied surgical indications with low rates of intraoperative and postoperative complications. (Chin J Ophthalmol, 2018, 54:918-922).

Air-Perfused 23-Gauge Sutureless Diabetic Vitrectomy for Control of Intraoperative Bleeding during Removal of Fibrovascular Membrane

ABSTRACTPurpose: To demonstrate the advantages and efficacy of an air-perfused membrane dissection to control intraoperative bleeding in 23-gauge sutureless vitrectomy for proliferative diabetic retinopathy with severe fibrovascular membranes.Meterials and Methods: A prospective, consecutive, interventional case series of 15 eyes that underwent air-perfused diabetic vitrectomy (air vitrectomy group) for removal of the membranes was compared with a retrospective, membrane-matched case series of 10 eyes that underwent conventional diabetic vitrectomy (conventional vitrectomy group). The main outcome measures were real vitrectomy time, intraoperative and postoperative complications, and anatomic and functional successes at the final examination.Results: The incidence of intraoperative retinal tears was 30% (3/10 eyes) in the conventional vitrectomy group and 20% (3/15 eyes) in the air vitrectomy group (p > 0.05). The postoperative complications such as vitreous hemorrhage or tractional retinal detachment were not common in both groups during the 6-month follow-up (p > 0.05). In addition, the final anatomic and functional success rates did not differ significantly between the groups (p > 0.05). However, the vitrectomy time was significantly shorter in the air vitrectomy group (67.0 ± 21.8 min) than in the conventional group (84.6 ± 21.1 min) (p = 0.04).Conclusion: Air-perfused vitrectomy showed comparable anatomic and functional success rates and shorter surgical time, compared with conventional vitrectomy in diabetic eyes with severe fibrovascular membranes. We suppose that the shortened surgical time in the air vitrectomy group is related to less intraoperative bleeding and more efficient hemostasis.

Long-term Safety and Efficacy of Sutureless Vitrectomy for Combined Epiretinal and Internal Limiting Membrane Removal

Purpose: The purpose of this case series is to evaluate the long-term visual outcomes of patients undergoing epiretinal membrane (ERM) removal combined with internal limiting membrane (ILM) peeling via sutureless vitrectomy. Methods: A retrospective review was conducted of 45 patients (45 eyes) with ERMs treated with 25-gauge pars plana vitrectomy (PPV) from 2010 to 2011. Data assessed included baseline characteristics, preoperative and postoperative best-corrected visual acuity (BCVA), ERM recurrence rate during follow-up, and complications arising during follow-up. Results: PPV resulted in a statistically significant improvement in BCVA (20/61 preoperatively, 20/41 1 year postoperatively, and 20/45 at the end of follow-up). Mean duration of follow-up was 66.3 months (range, 26-89). Forty-one of 45 (91%) eyes had improved or stable vision, while 4/45 (8.9%) had worse vision. ERMs recurred in 12/45 eyes (26.7%), of which 1/45 (2.2%) required reoperation. The remaining 11 recurrent ERMs were documented as visually insignificant. Mean time to ERM recurrence was 29.3 months (range, 4-72). Conclusions: In one of the longest mean follow-up studies to date, small-gauge PPV for ERM and ILM removal results in statistically significant and stable long-term visual improvement. Despite ILM removal, ERMs did recur in a substantial proportion of patients, though the vast majority were not visually significant.

Sutureless 23-gauge Versus Sutureless 20-gauge Pars Plana Vitrectomy

Aim: To compare sutureless 23-gauge versus sutureless 20-gauge system for pars plana vitrectomy as regarding safety and efficacy in pars plana vitrectomy. Patients and methods: A prospective non –randomized interventional study comparing the two vitrectomy systems in a group of disease requiring uncomplicated vitreoretinal surgery was carried out at Nour- EL–Hayaha Eye Center (Cairo) between August, 2015 and June, 2017. Patients were divided into two groups. Group (A) 23 –gauge group: included thirty eyes of 20 patients, ten patients had bilateral pars plana vitrectomy (PPV), while in group (B): included twenty five eyes of 20patients, five patients had bilateral operations. Ocular examinations included measurements of best corrected visual acuity (BCVA) at a distance using a logarithm of the minimum angle of resolution (logMAR) scale, refractive status using an autorefractometer (KR-8100; Topcon corporation, Tokyo, Japan), IOP was measured pre and postoperative by Goldman applanation tonometry (CT-80; Topcon corporation, Tokyo, Japan), and fundus evaluation using an indirect ophthalmoscope were obtained. Surgical indication, outcome, intraoperative and postoperative complications were evaluated. Patients with vitreoretinal pathology such as preretinal membrane, vitreous haemorrhage with fibrovascular proliferation (FVP), persistent vitreous haemorrhage ,tractional retinal detachment, persistent macular edema or macular hole were enrolled in this study. Furthermore, postoperative subjective pain, conjunctival injection, retinal function and situation of retina were evaluated. Follow up was performed at the 1st day, 1st, 2nd week and 1st, 3rd and 6th month after surgery. Results: All the fifty five eyes completed the regularly follow up visits up to 24 months. 55 eyes of 40 patients divided into 2 groups: Group (A) 30 eyes of 20 patients (6 males, 30% and 14 females, 70%, the mean age of the participants ± SD was 54.62±3.12 years Range: 46-60 years;were treated with 23-gauge PPV .While in Group (B) twenty five eyes of 20 patients (13 males, 65% and 7 females, 35%, the mean age of the participants ± SD was 49.72±3.06 years Range: 50-58 years; were treated with sutureless 20-gauge PPV. The mean age of both groups ± SD was 52.67±5.14 years (Range: 47-62 years). Statistically, the differences between both groups regarding age and sex were insignificant. Conclusion: Advantages of sutureless vitrectomy include a reduction in operating time, less subconjunctival adhesion facilitating any subsequent vitreoretinal surgery or filtration surgery

Sutureless 23-gauge Versus Sutureless 20-gauge Pars Plana Vitrectomy

Aim: To compare sutureless 23-gauge versus sutureless 20-gauge system for pars plana vitrectomy as regarding safety and efficacy in pars plana vitrectomy. Patients and methods: A prospective non –randomized interventional study comparing the two vitrectomy systems in a group of disease requiring uncomplicated vitreoretinal surgery was carried out at Nour- EL–Hayaha Eye Center (Cairo) between August, 2015 and June, 2017. Patients were divided into two groups. Group (A) 23 –gauge group: included thirty eyes of 20 patients, ten patients had bilateral pars plana vitrectomy (PPV), while in group (B): included twenty five eyes of 20patients, five patients had bilateral operations. Ocular examinations included measurements of best corrected visual acuity (BCVA) at a distance using a logarithm of the minimum angle of resolution (logMAR) scale, refractive status using an autorefractometer (KR-8100; Topcon corporation, Tokyo, Japan), IOP was measured pre and postoperative by Goldman applanation tonometry (CT-80; Topcon corporation, Tokyo, Japan), and fundus evaluation using an indirect ophthalmoscope were obtained. Surgical indication, outcome, intraoperative and postoperative complications were evaluated. Patients with vitreoretinal pathology such as preretinal membrane, vitreous haemorrhage with fibrovascular proliferation (FVP), persistent vitreous haemorrhage ,tractional retinal detachment, persistent macular edema or macular hole were enrolled in this study. Furthermore, postoperative subjective pain, conjunctival injection, retinal function and situation of retina were evaluated. Follow up was performed at the 1st day, 1st, 2nd week and 1st, 3rd and 6th month after surgery. Results: All the fifty five eyes completed the regularly follow up visits up to 24 months. 55 eyes of 40 patients divided into 2 groups: Group (A) 30 eyes of 20 patients (6 males, 30% and 14 females, 70%, the mean age of the participants ± SD was 54.62±3.12 years Range: 46-60 years;were treated with 23-gauge PPV .While in Group (B) twenty five eyes of 20 patients (13 males, 65% and 7 females, 35%, the mean age of the participants ± SD was 49.72±3.06 years Range: 50-58 years; were treated with sutureless 20-gauge PPV. The mean age of both groups ± SD was 52.67±5.14 years (Range: 47-62 years). Statistically, the differences between both groups regarding age and sex were insignificant. Conclusion: Advantages of sutureless vitrectomy include a reduction in operating time, less subconjunctival adhesion facilitating any subsequent vitreoretinal surgery or filtration surgery

Transscleral tunnel incision related arterial hemorrhage in 23-gauge Vitrectomy: case report

BackgroundTransscleral tunnel incisions are commonly made to avoid postoperative leakage in small gauge sutureless vitrectomy. We present an unreported intraoperative complication, tunnel incision related arterial hemorrhage from sclerotomy, in 23-gauge (23G) vitrectomy.Case presentationTwo cases of intraocular arterial hemorrhage from superonasal sclerotomy were observed at the beginning of vitrectomy. The bleeding filled the vitreous cavity quickly and gushed out from the incision port after the involved supronasal cannula was removed. The active bleeding seemed not to stop spontaneously. We controlled the active bleeding by relocating the involved cannula, elevating the intraocular pressure and compressing the sclera wound. Post-operative intraocular hemorrhage from the sclerotomy was not found in any of the two cases.ConclusionsWe suggest that the bleeding was from injured ciliary artery when the incision crossed 3 or 9 o’clock accidently. Surgeons might avoid this complication by locating the superior incisions away from the horizontal axis, and should be aware the proper management.

Surgical outcomes of 27-gauge vitrectomy for rhegmatogenous retinal detachment with air tamponade

Objective To evaluate the efficacy and safety of 27-gauge sutureless vitrectomy with air tamponade for rhegmatogenous retinal detachment (RRD). Methods The clinical data of 35 consecutive eyes with primary RRD from 35 patients who received 27-gauge vitrectomy with intraocular air tamponade in Zhongshan Eye Center from April 2016 to January 2017 were retrospectively analyzed.The mean follow-up duration was 8.6 months.Best corrected visual acuity (BCVA) (LogMAR) and intraocular pressure (IOP) were examined before surgery, 1 week and 3 months after surgery.The operative duration, sclerotomy sites, retinal reattachment rate, intraoperative and postoperative complications were recorded. Results The mean duration of vitreous removal was (15.3±3.6) minutes, and the mean duration of operation was (34.5±4.8) minutes.No suturing process was performed at sclerotomy sites in all eyes.The retinal reattachment rate following a single procedure was 100%.The mean BCVA was significantly different among before surgery, 1 week and 3 months after surgery (F=64.12, P<0.01), and the BCVA at 1 week and 3 months after surgery was evidently improved in comparison with before surgery (0.82±0.31 vs. 1.01±0.40; 0.68±0.30 vs.1.01±0.40) (both at P<0.05). The mean IOP was (14.69±3.66), (17.37±2.32) and (16.69±2.45)mmHg (1 mmHg =0.133 kPa) before surgery, 1 week and 3 months after surgery, showing a significant difference among them (F=14.82, P<0.01), and the IOP 1 week and 3 months after surgery was evidently higher than that before surgery (both at P<0.05). The complications included intraoperative iatrogenic retinal breaks in 2 eyes, postoperative hypotony in 1 eye and hypertension in 5 eyes.These complications were curable. Conclusions 27-Gauge vitrectomy and air tamponade for RRD is an effective and safe approach. Key words: Vitrectomy/instrumentation; Vitrectomy/methods; Intraocular air tamponade; Rhegmatogenous retinal detachment/surgery; Treatment outcome; Complications; Retrospective studies

Vitreous rebleed following sutureless vitrectomy: Incidence and risk factors.

Purpose:This study aims to evaluate the incidence and risk factors for vitreous rebleed (VRB) following 25-gauge sutureless vitrectomy for vitreous hemorrhage (VH) in diabetic retinopathy.Methods:A retrospective review of 190 diabetic patients having undergone vitrectomy for VH at a tertiary eye care center was analyzed. Demographic data of patients along with risk factors such as blood sugar levels (BSL), blood pressure (BP), anticoagulant use, and pan-retinal photocoagulation status (PRP) were tabulated. Depending on the commencement of VRB, patients were divided into immediate rebleed-within 2 weeks and delayed rebleed-beyond 2–4 weeks.Results:Forty-one patients had VRB, out of which 18 patients had immediate VRB and 23 patients had delayed VRB. The average duration between vitrectomy and VRB was 3.28 months. Twenty-eight patients were male and 13 were females. Average age at presentation was 53.8 years. Thirty-four patients (82.9%) were found to have high BSL and 28 patients (68.3%) had high BP and they developed rebleed (P < 0.01) after an initial hemorrhage-free period (average = 5.15 months). Fifteen patients (36.6%) underwent first time PRP intraoperatively, and they had immediate rebleed (P < 0.01) without any hemorrhage-free period (average = 0.9 months). Eight patients (19.5%) were on perioperative anticoagulants; however, their statistical significance did not persist in the multivariable model. There were neither age nor gender predilection toward rebleed (P > 0.05).Conclusion:The incidence rate of VRB was found to be 21.6%. Age and gender did not contribute to rebleed. Intraoperative PRP was a risk factor for immediate rebleed. Poor glycemic and BP control was a risk factor for delayed rebleed.

A Modified Foveal Advancement Technique in the Treatment of Persistent Large Macular Holes.

To evaluate the outcomes of a new surgical technique on the closure of persistent large macular holes (MHs) PATIENTS AND METHODS:Data for 10 eyes of 10 patients who underwent surgical intervention for the treatment of large and persistent MHs were reviewed retrospectively. After entrance of the three-port transconjunctival 23-gauge sutureless vitrectomy instruments, a shallow perihole retinal detachment was formed by injecting a small amount of fluid with a 39-gauge /41-gauge subretinal cannula under the perihole (superior, temporal, and inferior sparing nasal bundle fibers) retina. Edges of the hole were brought closer with small, passive aspirations by a silicone-tipped cannula. After fluid-air exchange, a 39-gauge /41-gauge cannula was placed over the hole to remove submacular fluid. Then air was changed with 20% sulfur hexafluoride endotamponade. Mean minimum hole diameter was 691 μm ± 98 μm (range: 500 μm to 812 μm), and mean basal diameter was 1,604 μm ± 321 μm (range: 1,066 μm to 2,200 μm). Preoperative best spectacle-corrected visual acuities (BSCVAs) were lower than 20/200 in eight patients and were 20/200 in two patients. MHs were successfully closed in all eyes (100%). BSCVA did not change in two patients and were lower than 20/200. BSCVAs were 20/200 in six patients and greater than 20/200 in two patients. The ellipsoid zone (EZ) was lost in all patients. All the large and persistent MHs were successfully closed and stayed closed during follow-up period. However, increase in visual acuities was limited, which was related to the loss of the EZ. The authors' modified technique seems to be a good option for the surgical treatment of large and persistent MHs. [Ophthalmic Surg Lasers Imaging Retina. 2017;48:793-798.].

Anatomical and functional outcomes of retinectomies in retinal detachments complicated by proliferative vitreoretinopathy

PurposeTo study anatomical and functional outcomes of retinectomies in rhegmatogenous retinal detachments complicated by proliferative vitreoretinopathy. MethodsThis is a retrospective interventional consecutive case series of eyes with rhegmatogenous retinal detachments complicated by advanced proliferative vitreoretinopathy and managed by relaxing retinectomy over a period of seventeen years. Three-port pars plana vitrectomy included core vitrectomy and removal of all epi-retinal membranes. On failure to flatten, retina was cut and excised. Basal vitrectomy and removal of anterior flap of retina then followed. Silicone oil was used as temponade in majority of cases. The dependent variables were anatomical and functional outcomes. The statistical analysis was performed on SPSS 21. ResultsSeries included 370 eyes of 337 patients. Mean follow up was 39months. Scleral explant was used in 90(24.39%) cases. Two hundred and nine (56.49%) eyes were operated with trans conjunctival sutureless vitrectomy technique. Procedure was bilateral in 33 patients (09.79%). Retina attached in 311(84.05%) eyes after initial surgery. Final re-attachment after one or more surgeries was achieved in 344(92.97%) eyes. Two hundred and eleven (57.02%) cases achieved visual acuity of 6/60 or better. ConclusionRelaxing retinectomies have good and encouraging anatomical and functional outcomes. This surgery can be effectively carried out with trans conjunctival sutureless vitrectomy technique.