Transconjunctival Sutureless Vitrectomy Research Articles

Effect of transconjunctival sutureless vitrectomy versus 20‐G vitrectomy on surgical wound closure in patients: A meta‐analysis

AbstractA meta‐analysis was conducted to evaluate the impact of transconjunctival sutureless vitrectomy (TSV) over 20 G vitrectomy on wound healing, as well as the requirements for closing the wound in order to treat vitreoretinal diseases. Among the 500 cases who had been treated with vitrectomy to September 2023, 250 were treated by transconjunctiva without vitrectomy and 250 were treated with 20 G vitrectomy. The odds ratio (OR) and mean difference (MD) of 95% confidence interval (CI) were computed to evaluate the influence of wound opening and closing on vitrectomy diseases. The evaluation of vitreoretinal diseases was performed with either a random‐or fixed‐effect model, which involved TSV compared to 20 G vitrectomy. Compared to 20 G vitrectomy, the opening time of the wound in TSV was less (MD, −2.03; 95% CI, −2.87, −1.19; p < 0.0001); Compared to 20 G vitrectomy, the closing time of the wound was less (MD, −4.84; 95% CI, −6.38, −3.03; p < 0.0001); Nevertheless, there were no statistically significant differences in the incidence of vitreous haemorrhage after TSV surgery compared with 20 G vitrectomy (OR, 0.74; 95% CI, 0.25, 2.18; p = 0.59). TSV vitrectomy can shorten the duration of the operation and speed up the healing of the wound. It is suggested that additional studies be carried out with a larger sample size in order to verify this conclusion.

Wound healing and postoperative management in paediatric patients following 27-Gauge Transconjunctival Sutureless Vitrectomy for vitreoretinal conditions.

The utilization of 27-G TSV, or 27-Gauge Transconjunctival Sutureless Vitrectomy, poses distinct difficulties in the context of paediatric patients, particularly those younger than 14 years old, on account of the dearth of exhaustive documentation concerning the efficacy and results of these operations. Therefore, this retrospective study was to evaluate the safety and efficacy of 27-G TSV in paediatric patients, with emphasis on management of intraoperative and postoperative complications and postoperative wound healing. A total of 54 eyes of 52 paediatric patients who underwent 27-G TSV at Sichuan Provincial People's Hospital were included in the study. The average duration of follow-up was 9.32 ± 3.35 months. The complication with the highest incidence rate was Rhegmatogenous Retinal Detachment (RRD), which was detected in 27.8% cases. Familial Exudative Vitreoretinopathy (FEVR) and Persistent Fetal Vasculature (PFV) each accounted for 16.7% of the cases. Retinopathy of Prematurity (ROP) and Vitreous Haemorrhage (VH) constituted 11.1% and 14.8%, respectively, of the reported cases. Lens injury (1.9%), cannula slippage (7.4%) and wound leakage (5.6%) were intraoperative complications. Iatrogenic retinal detachment occurred at 3.7%. Hypotony (10.8% of patients), vitreous haemorrhage (9.3%), cataract formation (9.3%), ocular hypertension (8.1%) and retinal detachment (5.6%) were postoperative complications. Effective management strategies were executed, such as performing in situ trocar puncture to address cannula slippage and promptly suturing to address wound leakage. 27-G TSV exhibited promise as the therapeutic alternative for range of vitreoretinal disorders in paediatric patients, accompanied by complications that were controllable during and after the procedure. Strict preoperative planning and precise surgical technique are indispensable in order to maximize patient outcomes and guarantee effective wound healing and recovery within this particular demographic.

A novel approach for 25-gauge transconjunctival sutureless vitrectomy to evaluate vitreous substitutes in rabbits.

To improve the standard three-port vitrectomy for establishing and evaluating an endotamponade model in rabbits. Three ports were prepared near the third eyelid of rabbits, and the infusion port was placed at the inferior nasal quadrant with the inserted cannula linking with a self-designed handheld rigid infusion catheter. All right eyes of rabbits underwent a modified 25-gauge vitrectomy and were subsequently filled with balanced salt solution, silicone oil, and eight-arm polyethylene glycols (8-arm PEGs) hydrogel separately for comparison. Ophthalmic examinations were performed regularly to record the changes after the surgery. Successful vitrectomy was achieved among 44 chinchilla rabbits. The mean operation time was 4.51±1.25min. Four eyes (9.1%) presented limited lens touch and two eyes (4.5%) showed retinal touch during surgery. Incision leakage was found in three eyes (6.8%) after surgery. There was no endophthalmitis, hemorrhage, or retinal detachment during the observation period and ophthalmic examinations after the implantation of vitreous substitutes. The modified technique of the standard vitrectomy applied in the endotamponade model in rabbits shows excellent safety and practicality.

SCLERAL WOUND HEALING IN PARS PLANA VITRECTOMY : A NARRATIVE REVIEW

Background: Scleral wound healing involves cell death, migration, proliferation, differentiation, and ECM remodeling. Damaged connective tissue and blood arteries produce extravasation of blood cells, platelets, and plasma proteins when incisions are made in the conjunctiva and sclera (e.g. fibronectin, fibrinogen and plasminogen). Aims: This literature review aims to elaborate scleral wounds constructions in general, wound healing process, and closure of the scleral wound after pars plana vitrectomy. Methods: This literature review conducted 35 research publications from 2013-2022 who cited from some reputable sources using “wound healing”, “scleral”, “sutureless”, and “vitrectomy” as keywords. Results: The self-healing process that takes place after scleral wounds are closed. On the second day, fibrous tissue grows to fill in the wound gap, marking the beginning of the wound healing process. On the third day, the connective tissue was then expanded to span the entire thickness of the wound. On day five, the connective tissue begins to thicken and begins to align with the lamellae of the normal connective tissue that is around it. This process continues until day seven. On the seventh day, it looked that the wound had healed and normal tissue creation had taken place. Conclusion: Transconjunctival sutureless vitrectomy accelerated scleral wound healing. Small trocars and Zorro incisions speed scleral healing. Otherwise, silicone oil didn't affect scleral wound healing.

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.

Risk factors for secondary ocular hypertension in silicone oil-filled eyes following transconjunctival sutureless vitrectomy - A prospective cohort study.

Our aim was to determine the various risk factors for secondary ocular hypertension (OHT) following pars plana vitrectomy (PPV) with silicone oil (SO) injection. A prospective cohort study was performed on 46 eyes of 42 patients who underwent PPV with SO injection under a single surgeon between January 2020 and July 2021. Complete ophthalmological examination including gonioscopy and Goldmann applanation tonometry was performed preoperatively and on three postoperative visits, that is, day 7, day 30, and day 90. Axial length and lens thickness were measured at baseline using immersion A-scan. Anterior segment optical coherence tomography (OCT) was used for measuring anterior chamber depth (ACD) at baseline and at 3 months. There was a statistically significant increase in intraocular pressure (IOP) (>21 mmHg) on day 7 (4.70 ± 7.754 mmHg), day 30 (5.24 ± 7.481 mmHg), and day 90 (2.39 ± 5.659 mmHg) (P<0.01 for all). Age <50 years, rhegmatogenous retinal detachment (RRD), and pseudophakia had a strong association with short-term OHT on day 7. Preexisting glaucoma was the only independent risk factor for long-term OHT (day 90). Higher baseline IOP and SO emulsification also contributed to long-term OHT. There was a statistically significant elevation in IOP at all postoperative visits. Short-term OHT was associated with younger age (<50 years), RRD, and pseudophakia. Patients with emulsified SO in the anterior chamber, higher baseline IOP, and preexisting glaucoma were at higher risk for long-term OHT.

Surgical interventions for bilateral congenital cataract in children aged two years and under.

Surgical interventions for bilateral congenital cataract in children aged two years and under.

27-gauge vitrectomy for posterior segment eye disease: experience at a tertiary care center in Kashmir, India

Background: The aim of this work was to study the clinical outcomes, operative time, and complications of 27-gauge (27G) microincision vitrectomy surgery in posterior segment eye disease (PSED). Material and methods: This prospective observational study was conducted at a tertiary care hospital in Kashmir, India. 27G transconjunctival sutureless vitrectomy was performed on 101 eyes of 101 patients with PSED. Results: Of 101 patients, pars plana vitrectomy was indicated for retinal detachment (RD) (n = 36, 35.7%), vitreous hemorrhage (n = 35, 34.7%), epiretinal membrane (ERM)/vitreomacular traction (VMT) (n = 16, 15.9%), macular hole (n = 7, 6.9%), endophthalmitis (n = 4, 3.9%) and intraocular lens drop (n = 3, 2.9%). We observed significant improvement in mean logMAR visual acuity for all indications (p &lt; 0.05 each). Tamponade agents used were fluid (n = 51, 50.5%), silicone oil (n = 30, 29.7%), SF6 gas (n = 15, 14.85%), C3F8 gas (n = 3, 2.97%) and air (n = 2, 1.98%). The intraocular pressure (IOP) increased significantly in cases where silicone oil and SF6 gas were used as tamponade agents (p &lt; 0.05 each). Mean IOP initially increased on the first postoperative day followed by a gradual decline. Overall, the mean operating time was 37.08 minutes and duration of vitreous removal 22.41 minutes. Intraoperative complications included suprachoroidal hemorrhage (n = 1, 0.99%) and inadvertent retinal breaks (n = 1, 0.99%). Postoperative complications included transient hypotony (n = 2, 1.98%), transient ocular hypertension (n = 12, 11.88%), postoperative vitreous hemorrhage (n = 3, 2.97%), recurrent RD (n = 1, 0.99%) and emulsification of silicone oil (n = 3, 2.97%). Conclusions: The 27G system was safe and effective for treating a broad spectrum of PSED. Minimal complications and good visual outcomes warrant a wider adoption of this technique.

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.

Ultrasound biomicroscopy of sclerotomy sites after conventional and sutureless (23, 25 G) pars plana vitrectomy

Purpose To evaluate postoperative outcomes of transconjunctival sutureless pars plana vitrectomy (PPV), using ultrasound biomicroscopy (UBM), conventional PPV, and transconjunctival sutureless vitrectomy (TSV) sclerotomy sites were compared using UBM. Patients and methods A total of 30 patients underwent complete ophthalmological examination. Conventional PPV was performed following the same surgical techniques, and all TSV procedures were performed by one surgeon. The 20-, 23-, and 25-G vitrectomy systems were used, with 10 patients in each gauge. UBM examination was performed after 1–30 days following surgery to locate and document the sclerotomy sites. Results The 20, 23, and 25 G sclerotomies showed no statistical difference in site diameter at UBM. All patients had at least two diameters of the incision measured, and all wounds were constructed obliquely. The mean size of 20 G sclerotomy was 375.40±83.70 µm (range, 280.4–695 µm) and coefficient of variation was 0.21. The mean size of 23 and 25 G sclerotomy was 315.5±56.8 µm (range, 253.2–362.5 µm; coefficient of variation=0.26; P&lt;0.556). Conclusion Postoperative UBM examination allowed the evaluation of the wound architecture and showed no statistical difference between conventional 20 G and TSV 23, 25 G sclerotomies.

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.

Prognostic factors in Pars Plana vitrectomy for Proliferative Diabetic Retinopathy

Objective: To determine the factors associated with good visual outcome in eyes undergoing pars plana vitrectomy (PPV) for proliferative diabetic retinopathy (PDR). Furthermore, the objective of the study was to compare the clinical outcome and complications of standard 20 gauge vitrectomy with 23-gauge transconjunctival sutureless vitrectomy. Materials and Methods: This was a prospective interventional study performed on patients presenting at the Retina clinic of a tertiary eye care hospital in Salem, Tamil Nadu between October 2018 to November 2019. All eyes undergoing PPV for complications of PDR and having adequate follow were included. The patients were divided into two groups, one group undergoing standard 20 gauge vitrectomy and the other group undergoing 23 gauge transconjunctival sutureless vitrectomy. Results: A total of Forty-nine eyes (25 eyes underwent standard 20 gauge vitrectomy and 24 eyes underwent 23 gauge transconjunctival sutureless vitrectomy). Visual acuity improved significantly following PPV (p&lt;0.0001) and this improvement was seen in both 20 gauge group (p=0.0004) and in 23 gauge group (p=0.00005). There was no significant difference in best-corrected visual acuity noted between the two groups. However, eyes that underwent 23 gauge vitrectomy tended to gain vision earlier when compared to eyes that underwent 20 gauge vitrectomy. Complications following vitrectomy did not differ significantly between 20 gauge and 23 gauge group. Conclusion: Visual acuity improved significantly following PPV across all indications. Visual acuity in eyes that underwent 23 gauge TSV tended to gain vision earlier than eyes that underwent standard 20 gauge 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.

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).