Transconjunctival Vitrectomy Research Articles

Idiopathic vitreomacular traction and macular hole: a comprehensive review of pathophysiology, diagnosis, and treatment

Posterior vitreous detachment (PVD) is a common phenomenon in the aging eye. However, this may be complicated by persistent symptomatic vitreomacular adhesions that exert tractional forces on the macula (vitreomacular traction; VMT). VMT itself may be associated with epiretinal membrane formation and the development of idiopathic macular holes (IMH). Such pathologies may cause visual disturbances, including metamorphopsia, photopsia, blurred vision, and decreased visual acuity, which impact an individual's quality of life. Technologies such as optical coherence tomography allow an increasingly more accurate visualisation of the macular anatomy, including quantification of macular hole characteristics, and this facilitates treatment decision-making. Pars plana vitrectomy remains the primary treatment option for many patients with VMT or IMH; for the latter, peeling of the inner limiting membrane (ILM) of the retina has shown improved outcomes when compared with no ILM peeling. The development of narrow-gauge transconjunctival vitrectomy systems has improved the rate of visual recovery following surgery. Ocriplasmin, by degrading laminin and fibronectin at the vitreoretinal interface, may allow induction of PVD in a non-invasive manner. Indeed, clinical studies have supported its use as an alternative to surgery in certain patient populations. However, further research is still needed with respect to greater understanding of the pathophysiology underlying the development of VMT and IMH.

Fibrovascular Ingrowth After 25-Gauge Transconjunctival Vitrectomy in Proliferative Diabetic Retinopathy

The authors describe two patients with proliferative diabetic retinopathy bilaterally who were treated with transconjunctival 25-gauge pars plana vitrectomy (PPV) for dense vitreous hemorrhage (VH). After 4 and 10 months, respectively, both developed recurrent VH. They were initially managed with in-office gas-fluid exchange and anti-VEGF intravitreal injection. Soon after gas bubble resorption, the VH recurred. Color external photos revealed engorged episcleral vessels superotemporally, and ultrasound biomicroscopy confirmed the presence of fibrovascular ingrowth (FVI) at the sclerotomy site in both patients. They were successfully treated with a slightly modified 25-gauge PPV technique. Although FVI is well-recognized following conventional 20-gauge vitrectomy, this report is the first to detail FVI arising after small-gauge transconjunctival vitrectomy.

Small-gauge transconjunctival vitrectomy with phacoemulsification in the pupillary plane of dense retained lens matter on perfluorocarbon liquids after complicated cataract surgery

To evaluate the visual outcomes, efficacy, and complications of 23-gauge pars plana vitrectomy followed by phacoemulsification using torsional ultrasound of dense retained lens matter on perfluorocarbon liquids (PFCLs) after complicated cataract surgery. The case notes of 34 consecutive patients operated upon with retained lens matter after complicated cataract surgery by one surgeon were reviewed. Twenty-one of the 32 cases were able to be managed using the vitrectomy cutter alone, but 13 cases with dense lens matter were managed using 23-G vitrectomy followed by torsional ultrasound of the retained lens via the original corneal incision after floating it up to the pupillary plane on PFCLs. Case notes of these 13 patients were reviewed to ascertain clinical features, results, and any complications. The mean age of the 13 patients was 79years. The procedure was completed in all cases without using an intravitreal fragmatome. All cases were aphakic prior to vitrectomy surgery. Ten patients had a sulcus fixated IOL inserted at the time of vitrectomy and three had an angle-supported anterior chamber IOL inserted. Mean post-operative visual acuity at 3months was 0.24 (median 6/9). Eleven of the 13 patients (85%) had a best postoperative corrected visual acuity of ≥6/12. One patient developed cystoid macular oedema that was successfully treated. There were no cases of retinal detachment. The outcome of 13 patients operated on with transconjunctival vitrectomy with phacoemulsification of dense retained lens matter on top of PFCLs is described. The technique was used successfully, with good visual acuity outcomes and a low complication rate.

Rate of Hypotony Following 25-Gauge Pars Plana Vitrectomy

To report the rates of hypotony after 25-gauge vitrectomy. A retrospective review of 111 consecutive cases was performed in patients undergoing transconjunctival 25-gauge pars plans vitrectomy with either air or gas as a tamponade agent. The primary outcome measure was postoperative intraocular pressure less than 5 mm Hg. A Wilcoxon rank-sum test was conducted to determine the statistical significance of continuous variables in association with rates of hypotony. The overall incidence of hypotony on postoperative day 1 was found to be 8.1%. The rate of hypotony was 16.7% in uveitis cases and 0% in routine macular surgery. The rate of hypotony in cases in which sutures were used was 41.7%, compared to 4% in cases in which sutures were not used (P = .001). Hypotony rates were significantly higher after 25-gauge transconjunctival pars plana vitrectomy in uveitis and some other conditions.

Application of 23G vitrectomy for preretinal hemorrhage and sub-inner limiting membrane hemorrhage

Objective To observe the application of 23-gauge vitrectomy in treating preretinal hemorrhage and inner limiting membrane hemorrhage.Methods The clinical data of 23-gauge vitrectomy for treatment of preretinal hemorrhage and inner limiting membrane hemorrhage in 9 cases (9 eyes) were analysed.Results The preretinal hemorrhage and inner limiting membrane hemorrhage were cleared in 9 cases,and visual acuity improved.Conclusion 23-gauge transconjunctival vitrectomy is a safe and effective surgical procedure for preretinal hemorrhage and inner limiting membrane hemorrhage with quick recovery and less complication. Key words: Preretinal hemorrhage; Inner limiting membrane hemorrhage ; 23-gauge vitrectomy system

Different techniques of transconjunctival cannulated vitrectomy versus conventional non-cannulated vitrectomy in various vitreoretinal disorders

PurposeTo evaluate the safety and efficacy of different methods of transconjunctival cannulated vitrectomy versus conventional non-cannulated vitrectomy in various vitreoretinal disorders.MethodsA prospective randomized study was done from August 2009 to February 2011. The study included 129 eyes of 122 patients, randomly divided into four groups. Group 1 comprised 34 eyes operated on using transconjunctival 20-gauge cannula Claes system. Group 2 comprised 32 eyes operated on using transconjunctival cannulated 23 gauge system. Group 3 comprised 27 eyes operated on using combined 20-gauge non-cannulated and 23-gauge transconjunctival cannulated system. Group 4 comprised 36 eyes operated on using conventional non-cannulated 20-gauge system.ResultsThe four groups were demographically similar. Anatomical outcome was achieved in all cases. Vision was improved in 29 eyes (85.3%) in group 1, 23 eyes (71.9%) in group 2, 19 eyes (70.4%) in group 3, and 26 eyes (72.2%) in group 4. There was no statistical difference between the four groups 1-day postoperative (P=0.405) and 1-week postoperative intraocular pressure (P=0.254). The number of sutureless sclerotomies was 68 (66.6%) in group 1, 78 (81.3%) in group 2, 50 (61.8%) in group 3, and 0 in group 4. Hypotony occurred in one eye (2.9%) in group 1, three eyes (9.4%) in group 2, two eyes (7.4%) in group 3, and no eyes in group 4. Operative endophthalmitis did not occur in any one of the four groups.ConclusionFinal anatomical and functional outcomes were not related to the type of sclerotomy used (cannulated or non-cannulated), the gauge used (20 or 23), the route (transconjunctival or transscleral), or type of suture used. The advantages of small-gauge transconjunctival vitrectomy were patient comfort, early ambulation, and preservation of the conjunctiva. This should be weighed against the cost of this cannula system.

Long-Term Outcome of Preoperative Disrupted Inner/Outer Segment Junctions Assessed Using Spectral-Domain Optical Coherence Tomography in Patients with Idiopathic Epiretinal Membrane

Purpose: To evaluate the anatomic and functional outcomes as assessed by spectral-domain optical coherence tomography in patients with a preoperative disrupted or irregular photoreceptor inner/outer segment (IS/OS) junction who underwent idiopathic epiretinal membrane (ERM) surgery and were followed for at least 2 years. Methods: We retrospectively studied all of the patients with idiopathic ERM who had a preoperative disrupted IS/OS junction and were scheduled to undergo a transconjunctival 25-gauge vitrectomy between September 2007 and October 2009. All of the patients who had a 2-year or longer follow-up period were included in the study. The best-corrected visual acuity (BCVA) and structural changes in the IS/OS junction were examined before and 3, 6, 12, and 24 months after surgery. Furthermore, patients were divided into two groups based on whether the preoperative disrupted IS/OS junction had been caused by a lamellar macular hole (LMH type) or swelling as a result of ERM traction (S type). Morphologic changes in the IS/OS junctions of each type were also investigated. Results: A total of 17 patients were identified in this study. Overall, a significantly better postoperative BCVA was seen after surgery; in particular, the BCVA at 24 months was significantly better than that at 12 months (p = 0.018). Although the disrupted IS/OS junction appeared normal in 1 out of 17 eyes at 12 months, 7 eyes appeared normal at 24 months. These 7 eyes showed significant postoperative improvement in BCVA compared with the remaining 10 eyes (p = 0.045, p = 0.021, p = 0.019, and p = 0.015 at 3, 6, 12, and 24 months, respectively). The preoperative disrupted IS/OS junction was classified as LMH type in 8 eyes and as S type in 9 eyes. The LMH type, rather than the S type, tended to show a persistently disrupted IS/OS junction at 24 months, although the difference was not significant. Conclusion: Anatomic and functional recovery of preoperative disrupted IS/OS junctions can be acquired even after more than 1 year postoperatively. However, eyes with persistent irregularities of the IS/OS junction at a 2-year follow-up, especially those with LMH type irregularities, might have a limited visual improvement.

23-gauge transconjunctival sutureless vitrectomy in treatment of post-operative endophthalmitis

To report the safety and efficacy of 23-gauge (23-G) transconjunctival vitrectomy (TSV) in the surgical management of postoperative endophthalmitis. Ten consecutive patients underwent a 23-G TSV in 2008-2010 after cataract surgery (n = 5) or filtrating surgery (n = 5), and were prospectively studied with a minimum follow-up of 6 months. TSV was performed within a median delay of 1 day after the diagnosis, after one or two injections of intravitreal antibiotics (vancomycin, ceftazidime). Conventional cultures (brain heart infusion media) and/or panbacterial PCR were performed on aqueous humor and/or vitreous samples. Initial visual acuity was less than or equal to hand motion in all cases, and clinical findings included hypopyon (80%), pupillary fibrin membrane (80%), and dense vitreitis (4+, 100%). The bacteria identified were Gram-positive cocci in 60% of the cases (coagulase-negative staphylococci, 20%; streptococcus, 40%) and Gram-negative bacilli in 10% (moraxella lacunata). All patients had central and peripheral vitrectomy (mean duration, 58.6 ± 16 min). No intraoperative complications were noted. Two patients developed retinal detachment postoperatively and were reoperated. The final visual vision was 20/400 for two patients and 20/50 or better for the other patients. 23-G TSV allows the surgeon to meet the same objectives as the 20-G technique for the treatment of endophthalmitis.

Comparison of Efficacy and Safety between Transconjunctival 23-Gauge and Conventional 20-Gauge Vitrectomy Systems in Macular Surgery

PurposeTo compare the efficacy and safety of 23-gauge transconjunctival vitrectomy with the conventional 20-gauge method in idiopathic epiretinal membrane and macular hole surgery.MethodsSixty-one consecutive patients undergoing vitrectomy for idiopathic epiretinal membrane and macular hole were recruited to either 20- or 23-gauge vitrectomy groups and prospectively evaluated. Surgical success rates, operating time, surgery-related complications, long-term visual outcomes, and postoperative ocular surface problems are compared in the two groups.ResultsThere were 31 eyes in the 20-gauge group and 33 eyes in the 23-gauge group. The macular hole closure rate after the first surgery was 83% and 90.9% in the 20-gauge and 23-gauge groups, respectively, with no significant difference between groups (p = 0.59). The success rate for idiopathic epiretinal membranes cases was 100% in both groups. There was no statistically significant difference between overall surgical times (p = 0.90). None of the patients in either group experienced postoperative complications of severe postoperative hypotony, vitreous hemorrhage or endophthalmitis, except one eye in the 20-gauge group, which was found to have retinal detachment. In both groups, statistically significant improvement in visual acuity was achieved 1-month postoperatively (p = 0.002) and thereafter at all postoperative visits (p < 0.05). The mean ocular surface scores were significantly lower in the 23-gauge group at all postoperative visits compared with the 20-gauge group scores (p = 0.001).ConclusionsTransconjunctival 23-gauge vitrectomy appears to be as effective and safe as conventional 20-gauge vitrectomy in idiopathic epiretinal membrane and macular hole surgeries.

Endophthalmitis following vitrectomy

Sir, We read with interest the article by Patel and Rahman,1 whose study involved an online survey aimed at members of the Britain & Eire Association of Vitreoretinal Surgeons (BEAVRS) to disclose their experience with endophthalmitis following smaller gauge vitrectomy surgery. Two cases of endophthalmitis following 4944 transconjunctival 23G vitrectomy operations were noted, providing an estimate for the incidence of 1 in 2472. As the authors highlight, this remains an estimate due to the low response rate (31%) and lack of documentary evidence. However, it is reassuring that this study has not revealed a dangerously high rate for this severe complication as sutureless vitrectomy has now become the mainstay in an increasing number of vitreo-retinal centers. Previous studies have differed greatly with respect to the estimated incidence of endophthalmitis following sutureless vitrectomy—exemplified by the study at Wills Eye Hospital2 finding the rate to be more than 12 times higher than that following sutured vitrectomy and contrasting with another American collaborative study3 that recently found no increased rate of endophthalmitis following sutureless surgery. These studies are limited by their retrospective nature and coverage of a relatively small catchment area. In order to establish a more reliable incidence for endophthalmitis following vitrectomy in the United Kingdom, we have currently completed 15 months of prospective, national surveillance (in association with the British Ophthalmic Surveillance Unit, BOSU), and received 18 reports of endophthalmitis following vitrectomy—14 of which meet our case definition. Given that data from the Hospital Episode Statistics disclose that ∼20 000 pars plana vitrectomies are performed each year, this provides an approximate incidence of 1 in 1800 before adjusting for underreporting (yet to be established with the use of validation centers). This framework that BOSU helps to provide is well suited to rare complications providing prospective surveillance across a large geographical area. National surveillance for this complication terminates in May 2012 and we urge all UK ophthalmologists to report cases to us via BOSU or directly to ten.shn@krapnahtanoj in order to investigate this disastrous complication thoroughly.

Passive Silicone Oil Removal in 23-Gauge Transconjunctival Vitrectomy

The authors introduce a feasible technique of passive silicone oil removal via the pars plana using 23-gauge transconjunctival vitrectomy microsurgery instruments. The procedure consists of three-port transconjunctival insertion of 23-gauge microcannulas. An inferotemporal cannula is connected to an infusion line and the height of the bottle is raised. The other two open ports are used to remove intravitreal silicone oil with an externally applied cotton swab. Passive silicone oil removal was conducted using the 23-gauge system in 46 phakic or pseudophakic eyes with silicone oil of both 1,000 (n = 39) and 5,000 centistokes (n = 7). A suture was placed for one of three sclera entry sites in 17 eyes. Cataract extraction with phacoemulsification was combined with passive silicone oil removal in 14 eyes. Transient hypotony was observed in 2 eyes. No retinal redetachment or other procedure-related complications were encountered.

Clinical analysis of 23-gauge transconjunctival vitrectomy system in treating Terson' s syndrome

Objective To evaluate the effect of 23-gauge transconjunctival vitrectomy system in treating Terson syndrome,and to assess the impact of operating-timing on the prognosis.Methods 11 cases with Terson' s syndrome was treated with 23-gauge transcomjunctival vitrectomy system,some of them with peeling of epiretinal membrane,intraocular laser coagulation,tamponading of air or expansive gases.Results All patients' vitreous were clear after the surgey and the visual acuity was improved inordinately.Conclusion 23-gauge transconjunctival vitrectomy system therapy of vitreous hemorrhage in Terson' s syndrome is a safe and effective surgical procedure,which has quick recovery,simple operation and less complication.The earlier surgery is good for recovery. Key words: Terson's syndrome; Vitreous hemorrhage; 23-gauge transconjunctival vitrectomy system

PREOPERATIVE INNER SEGMENT/OUTER SEGMENT JUNCTION IN SPECTRAL-DOMAIN OPTICAL COHERENCE TOMOGRAPHY AS A PROGNOSTIC FACTOR IN EPIRETINAL MEMBRANE SURGERY

To evaluate the macular structure on spectral-domain optical coherence tomographic (SD-OCT) images to predict the outcome of surgery for idiopathic epiretinal membrane. Forty-five eyes of 45 consecutive patients with idiopathic epiretinal membrane who had a preoperative visual acuity of ≤ 20/32 and were scheduled to undergo a transconjunctival 25-gauge vitrectomy were involved in this prospective cohort study. The best-corrected visual acuity (BCVA) and SD-OCT images of the fovea were examined before the surgery and at 3, 6, and 12 months after the surgery. Associations between the visual acuity parameters and the preoperative SD-OCT features, including the morphology of the photoreceptor inner segment/outer segment junction, macular thickness, presence/absence of retinal cysts, and presence/absence of a macular pseudohole, were investigated as predictors of the outcome of the surgery. The main outcome measures were the association between the macular microstructure on preoperative SD-OCT images and the visual acuity parameters, such as the BCVA, at 12 months after the surgery (postoperative BCVA) and the difference between the preoperative visual acuity and the postoperative BCVA. A total of 45 patients were enrolled in this study. The postoperative visual acuity was significantly better for the eyes with an intact inner segment/outer segment junction on the preoperative SD-OCT images than for those with an irregular or a disrupted inner segment/outer segment junction on the images (P < 0.001). Better preoperative visual acuity was associated with better visual acuity at 12 months and a lesser degree of improvement in the visual acuity (P < 0.001, respectively). The presence of an intact inner segment/outer segment junction on the preoperative SD-OCT images was found to be an important predictor of better visual recovery and better postoperative BCVA after epiretinal membrane surgery.

Comparison of postoperative inflammation and patient discomfort scores following 23-gauge and 25-gauge transconjunctival vitrectomy

Comparison of postoperative inflammation and patient discomfort scores following 23-gauge and 25-gauge transconjunctival vitrectomy

Repositioning a dislocated intraocular lens in the ciliary sulcus using 23-gauge sutureless pars plana vitrectomy

Intraocular lens (IOL) dislocation is a common complication of phacoemulsification. We describe a technique for retrieving a dislocated IOL using 23-gauge transconjunctival sutureless pars plana vitrectomy and repositioning the IOL in the ciliary sulcus in cases with adequate capsule support. This technique provides the benefits of sutureless surgery despite the complication of a dislocated IOL.

ADJUNCTIVE USE OF A NOVEL RELEASABLE SUTURE TECHNIQUE IN TRANSCONJUNCTIVAL VITRECTOMY

The purpose of this study was to determine the merits of a transconjunctival vitrectomy with the releasable suture technique in a large series of 20-gauge, 23-gauge, and hybrid trocar vitrectomy and to assess its effectiveness in minimizing the occurrence of incompetent wound closures. One hundred and one patients, with a variety of vitreoretinal disorders, and totaling 125 eyes, were enrolled. Each entry site wound was closed, with the releasable suture technique using 8-0 nylon. Postoperatively, sutures were released under a slit lamp at the office a mean 22.9 hours after surgery. In addition to the usual intraoperative and postoperative identification of complications, preoperative and postoperative intraocular pressures were monitored. The full results from all 337 sclerotomies (206, 20 gauge; and 131, 23 gauge) were assessed. It was observed that there were no significant differences between preoperative and postoperative intraocular pressure measurements (P > 0.05); no eyes required fluid or gas supplements, there was no significant wound leakage or hypotony; and no significant complications occurred, such as endophthalmitis or choroidal detachment. These results indicate that transconjunctival vitrectomy with releasable sutures, including those conducted with larger instrument trocar systems, offer patients excellent chances for a favorable outcome without incidences of postoperative wound leakage or hypotony.

Outcomes of 23-gauge pars plana vitrectomy in vitreoretinal diseases

PurposeThe aim of this study was to assess the efficiency and reliability of the 23-gauge (23G) transconjunctival vitrectomy system and examine possible complications of this surgical technique in a variety of vitreoretinal conditions along with early postoperative intraocular pressure (IOP) changes.Materials and methodsA total of 350 eyes of 324 patients having undergone 23G transconjunctival vitrectomy were included in this prospective study. A total of 150 (46.2%) were male and 174 (53.8%) female, with a mean age of 61.28 ± 15.67 years. Mean follow-up time was 8.3 months.ResultsMean BCVA logMARs were as follows: preoperatively 0.839 ± 0.59, postoperatively first day 2.07 ± 0.76, first week 1.14 ± 0,43, first month 0.63 ± 0.26 and last examination 0.359 ± 0.17. Mean BCVA decreased significantly (P < 0.001, P < 0.028, respectively) on postoperative first day and first week, mainly due to air or gas tamponade, and increased significantly in the first month and final control in almost all indications (P < 0.001). Postoperative mild hypotony (IOP ≤ 10 mmHg) was detected in 112 (32%) eyes on day 1 and in 59 (16.8%) eyes in week 1. While postoperative serious hypotony (≤5 mmHg) was detected in 34 (9.7%) eyes on day 1, it was not detected in any eyes at the end of the first week. None of the eyes required an additional gas tamponade or any other procedure in the early postoperative period due to hypotony. A total of 13 (3.7%) eyes were reoperated for recurrent vitreous hemorrhage; 23 (6.5%) eyes were reoperated on a second time, nine (2.5%) a third time, and 1 (0.2%) a fourth time for recurrent rhegmatogenous retinal detachment. Postoperative fibrinoid reaction was seen in 17 (4.8%) eyes on the first day and responded well to the medications. Cataract development was found in 61 (22.5%) of the 270 phakic eyes after a mean duration of 6.4 ± 3.5 months. Anatomical success was obtained in 86% of the patients and functional success in 72%.ConclusionThe 23G transconjunctival vitrectomy system is safe and effective in a wide field of vitreoretinal conditions. It is a good alternative to 20G and 25G techniques but needs some improvement mainly in regards to the instruments and related techniques; further larger controlled group studies are needed.

Diagnosing and Treating Vitreomacular Adhesion

Perifoveal vitreous detachment with residual vitreofoveal adhesion is considered as the first stage of posterior vitreous detachment. A key point is the transition from an innocuous vitreomacular adhesion (VMA) to a pathological vitreomacular traction (VMT). By using optical coherence tomography (OCT), VMA is defined as adhesion of the posterior hyaloid cortex involving the centre of the foveal region with or without a hyper-reflective signal on the inner surface of the retina. VMT is diagnosed when the inner macular surface slopes steeply, or sharp angulation and localised deformation of the retinal profile is detected at the VMA site. Otherwise, VMA is simply considered to be persistent adherence of the cortical vitreous. The tractional effects of perifoveal vitreous detachment cause a variety of macular pathologies determined by the size and the strength of the residual vitreoretinal adhesion. Vitreomacular adhesion plays a major role in the development of diseases such as vitreomacular traction syndrome (VMTS), macular hole, epiretinal membrane, tractional macular oedema and myopic macular retinoschisis. In addition, clinical evidence supports the theory that the course of diabetic retinopathy and age-related macular degeneration may be strongly influenced by an incomplete posterior vitreous separation. The current standard of care of vitreomacular interface pathologies is vitrectomy and membrane peeling – a procedure that is thought to relieve epiretinal traction – followed by regeneration of the retinal architecture and recovery of visual function. Over the last few years, with the introduction of 25-gauge (0.50mm) and 23-gauge (0.72mm) instruments, there has been another major shift toward transconjunctival microincisional vitrectomy surgery (MIVS). Pharmacological induction of posterior vitreous detachment (PVD) can become a further step toward a real ‘minimally invasive vitreous surgery’ for VMTS.

Comparison of retinal breaks observed during 23 gauge transconjunctival vitrectomy versus conventional 20 gauge surgery for proliferative diabetic retinopathy

BackgroundTo assess the rate and type of retinal break formation in patients undergoing 23 gauge transconjunctival vitrectomy surgery for complications of proliferative diabetic retinopathy compared with 20 gauge vitrectomy surgery.MethodsRetrospective case notes review of two consecutive series of patients who had primary pars plana vitrectomy for complications of proliferative diabetic retinopathy by a single surgeon. The control group had standard 20 gauge vitrectomy surgery whilst the second group had 23 gauge transconjunctival vitrectomy surgery.ResultsEighty-five eyes were included in the 20 gauge group and 85 eyes in the 23 gauge group. The groups were well matched for surgical complexity and indications for surgery, as well as a variety of other preoperative variables. There was a significant reduction in the incidence of peripheral sclerotomy-related retinal breaks and lesions suspicious for breaks (4/85 [5%] 23 gauge versus 14/85 [16%] 20 gauge, P = 0.02) and posterior retinal breaks (3/85 [4%] 23 gauge versus 12/85 [14%] 20 gauge, P = 0.03). Six eyes (7%) in total had definite new retinal breaks of any type detected in the 23 gauge group compared with 16 (18.8%) in the 20 gauge group (P = 0.04). One patient in each group experienced a retinal detachment postoperatively related in both cases to a posterior retinal break associated with recurrent traction.ConclusionIn this series of patients, 23 gauge transconjunctival vitrectomy surgery was associated with a lower rate of retinal break formation than 20 gauge vitrectomy for proliferative diabetic retinopathy.

23-gauge vitrectomy assisted by combined endoscopy and a wide-angle viewing system for retinal detachment with severe penetrating corneal injury: a case report

BackgroundWe report a case of traumatic retinal detachment in an eye with severe corneal opacity that was successfully treated using 23 gauge (G) transconjunctival vitrectomy assisted by endoscope and a wide-angle viewing system.Case presentationA 22-year-old Japanese man was referred to our hospital with the suspicion of traumatic retinal detachment of the right eye, 1 month after an open globe eye injury due to fireworks. At the time of his first visit, his best-corrected visual acuity was hand motion in the right eye. A 23 G three port pars plana vitrectomy was conducted in combination with ophthalmic endoscope and a wide-angle viewing system. Endoscopy revealed a retinal detachment in the inferior quadrant with tiny retinal breaks. Primary reattachment of the retina was achieved by tamponade of SF6 gas. Five months after the vitrectomy, penetrating keratoplasty was performed and visual acuity recovered to 0.02. Optical coherent tomography revealed thinning of the retina, which might be the cause of the remaining poor vision.Conclusion23 G vitrectomy assisted by combined endoscopy and a wide-angle viewing system could be advantageous in managing visualization constraints due to penetrating trauma.