ULTRASOUND BIOMICROSCOPY IN RECENTLY POSTOPERATIVE 23-GAUGE TRANSCONJUNCTIVAL VITRECTOMY SUTURELESS SELF-SEALING SCLEROTOMY

Assessment of Zonular Integrity in Phakic Eyes Following Pars Plana Vitrectomy Using Ultrasound Biomicroscopy: A Prospective Paired Eye Comparative Study

PURPOSE

To assess zonular integrity in phakic patients post vitrectomy using ultrasound biomicroscopy (UBM).

DESIGN

Prospective, comparative, nonrandomized, double-masked, paired eye study.

METHODS

We used ultrasound biomicroscopy (UBM) to evaluate phakic patients with a history of unilateral pars-plana vitrectomy.

INCLUSION CRITERIA

(1) phakic patients with history of pars plana vitrectomy in one eye as the only procedure; (2) normal unoperated fellow eye; and (3) complete gas or air resolution from the vitreous cavity at the time of UBM assessment.

EXCLUSION CRITERIA

(1) monocular patients; (2) history of intraoperative lenticular trauma; (3) the use of silicone oil tamponade; (4) history of trauma or pseudoexfoliation in either eye; (5) history of other ocular conditions that can affect the integrity of zonules, such as uveitis or ectopia lentis; (6) eyes with extreme myopia or long axial length (> -8.00 D or >30.0 mm); (7) history of intravitreal injection in either eye; (8) age <18 years.

TECHNIQUE

A high-frequency (50 MHz) UBM device was used by a masked technician to obtain radial section images from zonular bundles at 8 different clock positions. Image quality was assessed in real time, captured, and saved. Two experienced masked observers (H.C. and C.B.) then assessed the quality of the images and graded the zonular findings. Only patients with adequate studies have been included. A unique grading system that was specifically devised for this study was used as the following: (0) clear, well-defined zonule(s); (1) uneven, disrupted zonules or stretched zonules; and (2) extensive loss of zonules. Each clock hour was graded according to this system and the total score was then calculated for each eye. In the primary outcome, 2 main groups were analyzed: vitrectomized eyes and healthy contralateral nonvitrectomized eyes. The mean total UBM score (TUS) from each group was compared and analyzed.

RESULTS

Thirty-five patients were recruited into this study. Eleven patients were male and 24 were female. The mean age was 66.3 years. Thirty patients had vitrectomy for vitreomacular interface disorders (either macular hole or epiretinal membrane), 1 patient had vitreous hemorrhage and the remaining 4 patients had rhegmatogenous retinal detachments. With regard to tamponade agents, SF6 was used in 21 (60%) patients, air in 9 (26%) patients, and C3F8 in 5 (14%) patients. The mean TUS in the vitrectomized eyes was 2.28 (SD 1.83) vs 2.24 (SD 1.77) in the nonvitrectomized eyes (P = .9531). Overall, in the comparative analysis of mean scores based on 2 graders' assessments for each clock position in vitrectomized and nonvitrectomized eyes, there were no significant differences noted between the groups.

CONCLUSION

This study found no evidence for a difference in the mean total UBM score in eyes following vitrectomy when compared to their contralateral healthy, nonvitrectomized eyes. This likely indicates that vitrectomy may not affect the integrity of zonules in phakic patients, at least for patients with vitreomacular interface disorders undergoing uncomplicated surgery.

Small-Gauge Vitrectomy for Macular Surgery Using a Systematic Approach to Wound Closure: 27-Gauge vs 25-Gauge

Purpose: To evaluate the effectiveness of and to compare vitrectomy performed with 25-gauge or 27-gauge instrumentation for macular surgery by assessing the surgical duration, wound closure, and complication rate using a systematic approach to wound closure. Methods: In this retrospective chart review, 125 25-gauge and 125 27-gauge consecutive small-gauge vitrectomy surgeries for epiretinal membrane, macular hole, vitreomacular adhesion, or a combination were analyzed during and immediately after surgery. Wound closure was performed using a systematic protocol. Results: Baseline characteristics were not statistically different between the 2 groups. The surgical duration was similar with 25-gauge vitrectomy and 27-gauge vitrectomy (P = .07). Although spontaneous wound closure was common in both groups, it was more common in the 27-gauge group (P = .22). Intraoperative and postoperative complications were uncommon in both groups. Conclusions: Findings show that 27-gauge vitrectomy is a safe, effective alternative to the more commonly used 25-gauge vitrectomy for macular surgery. Less manipulation was required to achieve wound closure with 27-gauge vitrectomy using a standardized wound-closure protocol. Smaller 27-gauge vitrectomy did not increase surgical time or complications over 25-gauge vitrectomy for macular surgery.

Reporting of Complications in Retinal Detachment Surgical Trials: A Systematic Review Using the CONSORT Extension for Harms

IMPORTANCE

Knowledge on the frequency and severity of complications in surgical trials for rhegmatogenous retinal detachment (RRD) is essential to determine whether surgical procedures are developed and compared adequately, taking into account not only efficacy but also harms.

OBJECTIVE

To review standards of reporting of complications in recent randomized clinical trials of RRD surgery.

EVIDENCE REVIEW

This systematic review included randomized clinical trials on RRD surgery published between January 2008 and January 2021 in Embase, MEDLINE, and Web of Science Core Collection databases. Titles, abstracts, and full-text articles retrieved were reviewed for eligibility by 2 independent authors. Eligible studies were evaluated against checklist items from the Consolidated Standards of Reporting Trials Extension for Harms criteria by 2 independent authors, and discrepancies were resolved by discussion with a third author.

FINDINGS

Fifty studies were included. The median number of checklist items fulfilled was 8 (range, 0-15), of a possible total of 18. Frequently reported items were discussions balanced with regard to efficacy and adverse events (42 studies [84%]) and inclusions of harm-associated timing of data collection (41 studies [82%]). The least frequently reported items were distinctions between expected and unexpected adverse events (1 study [2%]) and mentions of the use of a validated instrument to report adverse event severity (4 studies [8%]). Frequency of complications was commonly reported (29 studies [58%]) in contrast with complication severity (10 studies [20%]).

CONCLUSIONS AND RELEVANCE

This review suggests that severity of complications of RRD surgery has been infrequently quantified and reported in randomized clinical trials and potentially represents an important area of improvement in future RRD surgical trials.

Vitreous incarceration in sutured vs non-sutured sclerotomies after 25-gauge macular surgery

OBJECTIVES

To study the patterns of vitreous incarceration in sutured vs non-sutured sclerotomies in patients subjected to 25-gauge macular surgery.

METHODS

A prospective study of 135 eyes affected by epiretinal membrane or macular hole. Vitreal disposition was evaluated via ultrasound biomicroscopy (UBM) at the sclerotomy sites between 30 and 40 days after surgery, once the tamponade had completely disappeared.

RESULTS

In total, 349 sclerotomies (86.2%) of 99 patients were non-sutured while 56 sclerotomies (13.8%) of 36 patients were sutured at the end of the surgical procedure. Among the 36 patients with sutured sclerotomies, 15 out of 36 (41.6%) had at least two sclerotomies sutured. All the sclerotomy sites were evaluated (405 sclerotomies). Sclerotomy suture was significantly associated with a less aggressive pattern of vitreal incarceration (OR: 0.16, 95% CI: 0.07-0.35, p < 0.001). Compared to preoperative values, day 1 post operative IOP was not significantly different in patients with sutured sclerotomies, while patients with non-sutured sclerotomies had a significantly lower day 1 post operative IOP.

CONCLUSIONS

In 25-gauge macular surgery, UBM evaluation documented a higher rate of postoperative vitreous incarceration in the non-sutured sclerotomies, confirming the previously postulated role of the residual vitreous, left at the end of the surgery, in closing the sclerotomy site.

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

PURPOSE

To evaluate the surgical outcomes of the 27-gauge (G) vitrectomy system for the treatment of primary rhegmatogenous retinal detachment (RRD).

METHODS

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 3 months 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.

RESULTS

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 1 day (15.7 ± 7.0 mmHg) 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 1 day postoperative, it spontaneously resolved within 1 week without additional surgical intervention. No postoperative complications such as infectious endophthalmitis were observed throughout the follow-up period.

CONCLUSION

Our findings show that 27G PPV is both safe and effective for the treatment of primary RRD.

Comparative study of straight vs angled incision in 27-gauge vitrectomy for epiretinal membrane

Purpose

The purpose of this study was to compare straight and angled incisions in 27-gauge microincision vitrectomy in patients with epiretinal membrane (ERM).

Methods

Seventy-three eyes of 68 patients with ERM who underwent straight (35 eyes) or angled incision (38 eyes) for 27-gauge microincision vitrectomy were retrospectively evaluated.

Results

No statistically significant difference was found between the two groups in postoperative logarithm of minimal angle of resolution best-corrected visual acuity. The intraocular pressure and rate of hypotony 1 day postoperatively did not differ between the straight- and angled-incision groups (intraocular pressure: 11.5 vs 13.4 mmHg, respectively; rate of hypotony: 20% vs 8%, respectively). Surgical wound closing occurred by postoperative day 10 in both groups.

Conclusion

A straight incision is as safe and useful in ERM vitrectomy as an angled one.

Reconsidering the Postoperative Day 0 Visit for Retina Surgery

BACKGROUND AND OBJECTIVE

This study compares outcomes of patients who were examined on postoperative (PO) day 0 and PO day 1 following retina surgery.

PATIENTS AND METHODS

A nonrandomized, comparative, retrospective series of one vitreoretinal surgeon was conducted on 166 patients with a PO day 0 visit (approximately 5 hours following surgery) and 428 patients with a PO day 1 visit.

RESULTS

Among patients examined at PO day 0, 4.6% had hypotony (intraocular pressure [IOP] ≤ 5 mm Hg) and 1.8% needed intervention for elevated IOP (IOP ≥ 30 mm Hg) compared with 1.6% and 4.0% of patients, respectively, examined on PO day 1.

CONCLUSION

Following retina surgery, there is a similar percentage of patients with abnormal IOP when patients are examined on PO day 0 when compared with PO day 1. However, the rate of hypotony was statistically higher on PO day 0, and there was a trend toward more elevated IOP on PO day 1. [Ophthalmic Surg Lasers Imaging Retina. 2018;49:e52-e56.].

VITREOUS INCARCERATION IN SCLEROTOMIES AFTER VALVED 23-, 25-, OR 27-GAUGE AND NONVALVED 23- OR 25-GAUGE MACULAR SURGERY

PURPOSE

To study the patterns of vitreous incarceration at sclerotomy sites by ultrasound biomicroscopy in patients subjected to valved or nonvalved small-gauge pars plana vitrectomy.

METHODS

A prospective comparative study of 88 eyes affected by epiretinal membrane and macular hole. Patients were divided into four groups: valved or nonvalved 23-gauge (16 eyes each) and valved or nonvalved 25-gauge (20 eyes each); their vitreal disposition was compared by ultrasound biomicroscopy. Vitreal disposition was also assessed in 16 eyes of 16 patients subjected to valved 27-gauge pars plana vitrectomy.

RESULTS

Three vitreal patterns were identified: P0 (vitreous not visible or vitreous strand distant from the sclerotomy site), P1 (vitreous strand parallel to and in contact with the sclerotomy site), and P2 (vitreous strand entrapped in the sclerotomy site). The effect of valved trocar use on vitreous incarceration seemed to be somewhat beneficial, but no statistically significant effect could be shown (odds ratio: 0.85, 95% confidence interval: 0.42-1.74, P = 0.657). Similarly, no differences in vitreous incarceration were shown among vitrectomy gauges (23, 25, or 27) both in a model including valved trocars only (P = 0.858) and in a model with all available data (P = 0.935).

CONCLUSION

In 23- and 25-gauge macular surgeries, postoperative vitreous incarceration does not seem to be reduced using valved cannulas and was similar to that observed in 27-gauge surgery.

SURGICAL OUTCOMES OF 27-GAUGE VITRECTOMY FOR A CONSECUTIVE SERIES OF 163 EYES WITH VARIOUS VITREOUS DISEASES

We examined 27-gauge vitrectomy in a consecutive series of cases to evaluate the outcome of a sutureless 27-gauge vitrectomy system. The findings of this study demonstrate that for the treatment of a variety of ocular diseases, the 27-gauge vitrectomy system is as safe and effective as larger-gauge vitrectomy systems.

Purpose:

To evaluate the safety and efficacy of 27-gauge vitrectomy for various vitreoretinal disorders.

Methods:

In this retrospective comparative study, 163 consecutive eyes with various diseases that underwent 27-gauge pars plana vitrectomy with or without ultraspeed transformer by a single surgeon from June 2012 through December 2014 were analyzed in regard to best-corrected visual acuity, intraocular pressure, intraoperative and postoperative complications, and surgery time.

Results:

In 2 eyes (1.2%), peripheral retina breaks were encountered intraoperatively, yet no other complications were found in those eyes. No cases required larger-gauge vitrectomy. Mean best-corrected visual acuity improved from 20/58 (logarithm of the minimum angle of resolution, 0.46 ± 0.64) preoperatively to 20/32 (logarithm of the minimum angle of resolution, 0.20 ± 0.40) postoperatively (P < 0.001). Mean follow-up was 16.7 months (range, 6–33 months). Intraocular pressure remained stable throughout the postoperative course. Hypotony was seen in 15 eyes (9.2%) at 1-day postoperative, yet that spontaneously improved within 1 week. No case of retinal detachment or endophthalmitis was recorded. In macular surgeries, such as idiopathic epiretinal membrane and macular hole combined with cataract surgery, the mean surgery time was 32.1 ± 6.9 minutes with ultraspeed transformer (n = 38) and 37.1 ± 7.7 minutes without ultraspeed transformer (n = 40) (P = 0.004).

Conclusion:

The 27-gauge pars plana vitrectomy was found to be safe and effective for treating various vitreoretinal disorders.

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

PURPOSE

The purpose of this study was to compare 27-gauge (27G) with 25-gauge (25G) microincision vitrectomy in patients with epiretinal membrane (ERM).ParticipantsSeventy-four eyes of 66 patients undergoing 3-port pars plana vitrectomy using 27G or 25G instrumentation.

METHODS

Seventy-four eyes of 66 patients with ERM, who underwent 27G or 25G microincision vitrectomy were prospectively evaluated.

RESULTS

The mean operation time for vitrectomy was significantly longer in the 27G group than in the 25G group (9.9±3.5 vs 6.2±2.7 min, respectively, P<0.0001). No statistically significant difference was found between the two groups in terms of the mean operation time for ERM-inner limiting membrane peeling (27G vs 25G: 20.2±9.9 vs 16.1±9.3 min, P=0.14), although the time for vitreous cutting was longer in the 27G group (9.9±3.5 vs 6.2±2.7 min, respectively, P<0.0001). The flare value, intraocular pressure (IOP), and rate of hypotony 1 day after surgery did not differ between the 27G and 25G groups (flare value: 18.7 vs 17.2; IOP: 8.8 vs 9.7 mm Hg; rate of hypotony: 30 vs 35%, respectively). There was no significant difference in the surgically induced astigmatism between the two groups in the follow-up period. The mean time required for wound closure did not show a significant difference between the 27G and 25G groups (7.7 vs 8.6 weeks, respectively).

CONCLUSION

The 27G system is as safe and useful for ERM vitrectomy as the 25G system. Based on its potential, further improvement of 27G instruments could result in greater efficiency.

Comparison of 23-gauge sutureless sclerotomy architecture and clinical outcomes in macular and non-macular surgery using spectral-domain optical coherence tomography

PURPOSE

To compare the 23-gauge (23-G) sutureless vitrectomy incision architecture in macular and non-macular surgery, using anterior segment spectral-domain optical coherence tomography (SD-OCT), and to evaluated its influence on clinical outcomes.

METHODS

A prospective, observational case series of 43 patients who underwent primary transconjunctival 23-G pars plana vitrectomy (PPV) for macular and non-macular diseases. All sclerotomy wounds were imaged 1 day after surgery using the anterior segment module of SD-OCT (OCT Spectralis; Heidelberg Engineering, Heidelberg, Germany). Sclerotomy architecture, including good wound apposition, presence of gaping and misalignment of the roof and floor of the incisions were evaluated. Preoperative, intraoperative and postoperative medical record data were also prospectively collected.

RESULTS

  Incision gaping and misalignment of the roof and floor occurred more frequently in the superotemporal and superonasal quadrants than in the inferotemporal quadrant (p < 0.05) and was more frequent in the non-macular group than in the macular group (p < 0.05). The incidence of incision gaping increased significantly as the incision angle increased. In the macular group, the mean postoperative intraocular pressure (IOP) did not change from the preoperative value, whereas in the non-macular group, the mean IOP decreased significantly from 15.09 ± 2.58 mmHg preoperatively to 12.18 ± 3.25 mmHg on the first postoperative day (p < 0.005). The mean IOP did not differ significantly between the two groups of surgery at 1 week, and at 1 month postoperatively.

CONCLUSIONS

  In 23-G PPV, non-macular surgery is associated with a significant postoperative IOP decrease in comparison with macular surgery, which could be explained by the most remodelled wound architecture.

In vivo comparison of 23- and 25-gauge sutureless vitrectomy incision architecture using spectral domain optical coherence tomography

Purpose. To investigate the in vivo incision architecture using spectral domain optical coherence tomography (SD-OCT) in 23-gauge and 25-gauge transconjunctival sutureless pars plana vitrectomy (TSPPV). Methods. A prospective observational study of 22 eyes of 22 patients that underwent three-port 25-gauge (10 eyes) or 23-gauge (12 eyes) TSPPV was performed. The three sclerotomies sites in each eye were analyzed by Corneal Adapter Model (CAM) RTVue SD-OCT (Optovue Inc., Fremont, CA, USA) with wound cross-section images (longitudinal and transversal) on days 1, 7, and 30 postoperatively. Transversal and longitudinal length, location, angle between the conjunctival surface tangent and the incision plane, and architecture deformations were evaluated. Results. All patients (22 eyes) completed the study and surgeries lasted less than 60 minutes. All wounds were obliquely performed, 23-gauge mean angle was 23 ± 5°, and 25-gauge angule was 21 ± 4°. Twenty-three-gauge sclerotomy transversal mean length was 1122 ± 242 μm and 25-gauge transversal sclerotomy mean length was 977 ± 174 μm; 23-gauge longitudinal mean length was 363 ± 42 μm and 25-gauge longitudinal sclerotomy mean length was 234 ±19 μm; 23-gauge open wound thickness mean was 61 ± 28 μm and 25-gauge open wound thickness mean was 22 ± 6 μm. All results were statistically significant (P < 0.05). No vitreous incarceration or silicone oil residue was observed in incision sites with both gauges. Conclusions. The 23-gauge and 25-gauge architectural wound constructions were well visualized using CAM SD-OCT. Statistical differences between the two gauges were observed throughout the study period.

Incidence of retinal breaks in eyes undergoing 23-gauge or 20-gauge vitrectomy with induction of posterior vitreous detachment

PURPOSE

To compare the incidence rates of retinal breaks in eyes in which posterior vitreous detachment was induced during 23-gauge and 20-gauge vitrectomies to treat macular holes or preretinal membranes.

METHODS

We retrospectively reviewed 122 eyes of 115 patients with a macular hole or preretinal membrane who underwent induction of posterior vitreous detachment during 23-gauge vitrectomy (23-gauge group) and 61 eyes of 58 consecutive patients with the disorders who underwent induction of posterior vitreous detachment during 20-gauge vitrectomy performed by 1 surgeon.

RESULTS

No difference was found in the incidence rates of intraoperative retinal breaks between the 23-gauge (16% [20/122]) and 20-gauge (16% [10/61]) groups. A postoperative rhegmatogenous retinal detachment developed in 2 (2%) eyes in the 23-gauge group, whereas no eyes in the 20-gauge group had postoperative retinal breaks or rhegmatogenous retinal detachment. The incidence rates of retinal breaks in eyes with a macular hole and preretinal membrane did not differ significantly.

CONCLUSION

Posterior vitreous detachment induced during vitrectomy frequently results in intraoperative retinal breaks, the incidence of which may be independent of the gauge of the vitreous instruments. Surgeons should be alert to the development of retinal breaks.

Study of intraocular pressure after 23-gauge and 25-gauge pars plana vitrectomy randomized to fluid versus air fill

PURPOSE

To determine if a difference in intraocular pressure (IOP) exists after small-gauge pars plana vitrectomy randomized to fluid versus 80% sterile air fill.

METHODS

Ninety-two eyes undergoing 23-gauge and 25-gauge transconjunctival pars plana vitrectomy were randomized to fluid versus air fill, and IOP was measured at 5 different time points.

RESULTS

There is no difference in the mean IOP for eyes undergoing small-gauge pars plana vitrectomy randomized to fluid versus air fill after vitrectomy. Using 23-gauge instrumentation, the mean immediate and 2-hour postoperative IOPs were statistically lower than the mean preoperative IOP. The mean Postoperative Day 1 and Week 1 IOPs were statistically higher than the mean immediate postoperative IOP. Using 25-gauge instrumentation, the mean IOP was not statistically different at any time points in the 2 groups. When comparing 23-gauge with 25-gauge instrumentation, the immediate postoperative IOP was statistically lower and the rate of suture closure for sclerotomies was higher for 23-gauge vitrectomy.

CONCLUSION

When performing 23-gauge or 25-gauge pars plana vitrectomy, there was no difference in mean IOP for fluid- versus air-filled eyes. However, the mean IOP in the immediate postoperative period was statistically lower, and there was a higher rate of suture closure for 23-gauge compared with 25-gauge instrumentation.

Comparative study of 23-gauge vitrectomy versus 20-gauge vitrectomy for the treatment of rhegmatogenous retinal detachment

PURPOSE

To compare the safety and efficacy of 20- and 23-gauge pars plana vitrectomy (PPV) for the management of primary rhegmatogenous retinal detachment (RD) with proliferative vitreoretinopathy (PVR) grade B or less.

METHODS

This comparative nested case-control study included 35 consecutive 23-gauge transconjunctival PPV cases matched (1:1) with 35 cases of 20-gauge PPV (from a prospective cohort of 1,150 patients) for the baseline visual acuity (VA), axial length, lens and macular status, the location and number of breaks, and PVR grade. All patients had complete PPV, cryotherapy, fluid-gas exchange, and a minimum follow-up of 6 months. The exclusion criteria were eyes with previous vitreoretinal surgery, combined vitrectomy and cataract surgery, RD secondary to trauma or macular hole, diabetic retinopathy, aphakic eyes, giant tears, or posteriorly located breaks precluding treatment using transconjunctival cryotherapy.

RESULTS

Baseline examination disclosed pseudophakia in 77.1%, high myopia in 11.4%, 2.7 ± 2.2 retinal breaks/eye, attached macula in 37.1%, and PVR grade B in 24.3% of the cases. The mean operative time and intraoperative complication rate (11.4%) were similar in both groups. In the 23-G group, we noted three cases of iatrogenic retinal tears and one case of choroidal detachment secondary to a dislodgment of the infusion line. Suturing the sclerotomy sites or the conjunctiva was required in 5.7 and 51% of the eyes, respectively. The single reattachment rate was similar in both groups, 74.3% in the 20-G group, and 80% in the 23-G group. The final anatomical success rate was 97% in the two groups. Mean preoperative VA of 1.2 ± 0.9 logMAR improved similarly in both groups to 0.4 ± 0.4 at the 6-month visit. A final vision of 20/40 or better was achieved similarly in 62.9% of the eyes in the 20-G group and 60% in the 23-G group.

CONCLUSIONS

Twenty-three-gauge PPV provides anatomical and visual results similar to the 20-G technique for the management of uncomplicated rhegmatogenous RD.

Advantages and limitations of small gauge vitrectomy

Small gauge vitrectomy utilizing 23- and 25-gauge instrumentation has definite advantages, but also limitations, due to the physics of smaller instruments and sutureless surgery. Higher infusion and aspiration pressures are needed to remove the vitreous using 23- and 25-gauge probes. The advantages include decreased surgical times, less tissue manipulation, reduced inflammation and pain postoperatively with more rapid visual recovery. A disadvantage is greater instrument flexion than 20-gauge probes, making small gauge vitrectomy more appropriate for indications such as vitreous opacities, epiretinal membranes, macular holes, and simple retinal detachments. There are also some increased complications related to small gauge vitrectomy, including dislocation of cannulas intraoperatively, early postoperative hypotony, choroidal detachment, and possibly an increased risk of infectious endophthalmitis.