POSTOPERATIVE COMPLICATIONS AND INTRAOCULAR PRESSURE IN 943 CONSECUTIVE CASES OF 23-GAUGE TRANSCONJUNCTIVAL PARS PLANA VITRECTOMY WITH 1-YEAR FOLLOW-UP

Diabetic retinopathy: emerging concepts of current and potential therapy

Diabetic retinopathy (DR) is one of the leading causes of permanent central blindness worldwide. Despite the complexity and inadequate understanding of DR pathogenesis, many of the underlying pathways are currently partially understood and may offer potential targets for future treatments. Anti-VEGF medications are currently the main medication for this problem. This article provides an overview of the established pharmacological treatments and those that are being developed to cure DR. We firstly reviewed the widely utilized approaches including pan-retinal photocoagulation therapy, anti-VEGF therapy, corticosteroid therapy, and surgical management of DR. Next, we discussed the mechanisms of action and prospective benefits of novel candidate medications. Current management are far from being a perfect treatment for DR, despite mild-term favorable efficiency and safety profiles. Pharmacological research should work toward developing longer-lasting treatments or new drug delivery systems, as well as on identifying new molecular targets in the pathogenetical mechanism for DR. In order to find a treatment that is specifically designed for each patient, it is also necessary to properly characterize patients, taking into account elements like hereditary factors and intraretinal neovascularization stages for effective utilization of drugs. The current and potential approaches for diabetic retinopathy. Image was constructed using Biorender.com.

Wedge-Shaped Pars Plana Sclerotomies: Is It Still an Actuality in the Era of Microincision Vitrectomy?

PURPOSE

To describe and evaluate the effectiveness of wedge-shaped sclerotomies to close 25-gauge and 23-gauge transconjunctival pars plana vitrectomies.

MATERIALS AND METHODS

This prospective, consecutive, interventional study examined 50 eyes of 50 patients who underwent 25-gauge and 23-gauge vitrectomy with wedge-shaped sclerotomies.

RESULTS

The number of eyes requiring a wedge shape for sclerotomy closure and sclerotomies requiring sutures was collected. Three eyes had hypotony on Day 1. No statistically significant difference was observed between preoperative intraocular pressure and postoperative intraocular pressure on Days 15 and 30. No postoperative complications were observed during the follow-up period.

CONCLUSION

The wedge-shaped sclerotomy is a simple, fast, and effective technique that does not require extra surgical materials and could be applied to microincision vitrectomy.

Cyclodialysis cleft formation following Yamane secondary intraocular lens implantation

Purpose

To report two cases of hypotony with maculopathy related to cyclodialysis cleft after Yamane intraocular lens (IOL) implantation, and the use of localized transscleral cyclophotocoagulation (TSCPC) to successfully treat this condition.

Observation

1. 37 year-old man with childhood BB-gun related injury in the left eye (OS) and traumatic iridodialysis and angle recession underwent pars plana vitrectomy and Yamane IOL placement for subluxed traumatic cataract OS. Postoperative hypotony [intraocular pressure (IOP) 5–6 mmHg] and maculopathy with best corrected vision acuity (BCVA) of 20/200 at 1 month postoperative prompted referral, and localized TSCPC was performed. Nine days later sudden elevation of IOP occurred, responsive to treatment, and the hypotony and maculopathy resolved. 2. 87 year-old man with prior OS retinal detachments treated with scleral buckling, pars plana vitrectomy x 2, and cataract extraction with sulcus IOL ranging from 8 to 37 years prior presented with temporal sulcus IOL haptic penetration through the iris and dense vitreous hemorrhage. He underwent pars plana vitrectomy, IOL explantation and Yamane IOL placement OS. Postoperative hypotony (IOP 1–4 mmHg) and maculopathy with evidence of cyclodialysis cleft on ultrasonography at 1 month postoperative prompted referral. The patient underwent 2 rounds of localized TSCPC; after his second treatment, IOP ranged from 9 to 14 mmHg over the next 8 months and maculopathy resolved.

Conclusion and Importance

We highlight the risk of development of cyclodialysis cleft after Yamane IOL placement in highly traumatized eyes, and the benefit of localized TSCPC in such cases for cleft closure.

SUTURELESS CLOSURE OF 23- AND 25-GAUGE LEAKING SCLEROTOMIES WITH THE SCLERAL NEEDLING TECHNIQUE

PURPOSE

To describe and evaluate the efficacy of a novel technique, scleral needling (SN), for securing 23- and 25-gauge leaking sclerotomies in microincision vitrectomy surgery.

METHODS

A retrospective comparative review of consecutive cases of 23- and 25-gauge pars plana vitrectomy performed by a single vitreoretinal surgeon before the introduction of the SN technique (pre-SN; November 2016 to January 2017) and after the introduction of the SN technique (post-SN; November 2017 to January 2018) was conducted. The SN technique was implemented as an alternative to suturing, using a 30-gauge needle inserted perpendicularly through the full thickness of the sclera adjacent to the scleral opening, with the needle then immediately removed and sclerotomy closure confirmed.

RESULTS

A total of 203 eyes, 105 from pre-SN and 98 from post-SN, were included in the study. The number of eyes requiring suture closure was significantly reduced from 39% in the pre-SN group to 2% in the post-SN group (P < 0.001). The mean postoperative intraocular pressure and incidence of hypotony on Days 1 to 2, Days 3 to 20, and Days 21 to 50 was not significantly different between the pre-SN and post-SN groups. No major complications associated with the SN technique were noted during the study period.

CONCLUSION

The SN technique is a safe and simple method for effectively securing leaking sclerotomies in microincision vitrectomy surgery.

Comparison of safety and effectiveness between 23-gauge and 25-gauge vitrectomy surgery in common vitreoretinal diseases

PURPOSE

To assess and compare safety and effectiveness between 23-gauge and 25-gauge vitrectomy systems for the treatment of common vitreoretinal diseases in non-vitrectomized eyes.

METHODS

Retrospective evaluation of patients who underwent pars plana vitrectomy from April 2018 to December 2019 at the Department of Ophthalmology and Optometry at the Medical University of Vienna (MUV) for the following indications: macular epiretinal membrane, macular hole, macular lamellar hole, vitreous hemorrhage, vitreous opacities, vitreomacular traction syndrome and macular edema.

RESULTS

201 eyes of 195 patients that underwent 23-gauge (n = 105 eyes) or 25-gauge (n = 96 eyes) vitrectomy were included in this study. The mean best-corrected visual acuity (BCVA) improved at 1-3 months postoperatively and beyond 3 months in both gauge groups. Risk of any complication within 1 month postoperatively was lower in the 25-gauge group, but the difference was statistically not significant (HR [95% CI]: 0.95 [0.53; 1.70], p = 0.85). Intraocular pressure less than 5 mmHg was observed in 2 eyes (2%) in the 23-gauge group at the first postoperative day. Intraocular pressure elevation over 25 mmHg occurred in 5 eyes (2 eyes, 2%, in 23-gauge and 3 eyes, 3%, in 25-gauge group) at postoperative day 1, between 7 and 28 days in 5 cases (2 eyes, 2%, in 23-gauge and 3 eyes, 3%, in 25-gauge group), and in 2 eyes (2%) of the 23-gauge group at postoperative day 145 and 61, respectively. Retinal detachment occurred in 1 eye (1%) in the 23-gauge and in 3 eyes (3%) in the 25-gauge group. We did not observe any cases of endophthalmitis.

CONCLUSION

Results in terms of safety, surgical success and visual outcomes for the treatment of common vitreoretinal surgery indications seem to be comparable between 23-gauge and 25-gauge vitrectomy systems, indicating that the two gauge systems can be used equally in the clinical routine.

Ex-Press® versus Baerveldt implant surgery for primary open-angle glaucoma and pseudo-exfoliation glaucoma

PURPOSE

To compare surgical outcomes between Ex-Press^® (EXP) and Baerveldt glaucoma implant (BGI) surgeries for primary open-angle glaucoma (POAG) and pseudo-exfoliation glaucoma (PEXG) patients.

PATIENTS AND METHODS

This was a retrospective single-facility study. The inclusion criteria were that the patient's preoperative intraocular pressure (IOP) was > 21 mmHg and the post-surgery follow-up was > 1 year. We recruited 161 patients who had undergone a trabeculectomy with EXP (89 eyes) or BGI surgery (72 eyes). We compared these groups' postoperative IOP values and postoperative glaucoma medications, the reduction rate of corneal endothelial cell density (ECD), surgical outcomes, complications, the hospital stay duration, and the number of visits within 3 months post-surgery.

RESULTS

Both the EXP and BGI surgeries could significantly decrease the IOP. When the surgical success was defined postoperative IOP ≤ 21 mmHg, the surgical outcome of BGI was significantly better than EXP (p = 0.0148). When the surgical success was defined postoperative IOP ≤ 18, 15 , and 12 mmHg, the surgical outcomes between BGI and EXP surgeries were not significantly different (p = 0.0815, p = 0.331, and p = 0.910). The mean ECD reduction rate was significantly faster in the EXP group. The BGI patients had significantly shorter stays in the hospital and fewer visits within 3 months post-surgery (p < 0.0001).

CONCLUSIONS

BGI surgery could provide comparable surgical outcomes as EXP surgery for POAG or PEXG patients with high preoperative IOP. BGI surgery has some advantages: fewer post-surgery visits, less postoperative interventions, and a lower ECD reduction rate.

A relatively higher intraocular pressure set at the end of vitrectomy is associated with a more stable and rapid visual recovery for patients with vitreous haemorrhage

PURPOSE

To compare structural and functional improvements in patients with vitreous haemorrhage (VH) with different IOPs re-established at the end of pars plana vitrectomy (PPV).

METHODS

It is a prospective, randomized, comparative, interventional study. Ninety-five patients with nonclearing VH were randomized to receive PPV with normalized IOPs of 15 mmHg (Group I: 32 eyes), 25 mmHg (Group II: 32 eyes) and 35 mmHg (Group III: 31 eyes) at the end of surgery. The grade of vitreous opacity and best-corrected visual acuity (BCVA) on postoperative day 1, week 1, month 1 and month 3 were compared with a mixed model for repeated measures analysis.

RESULTS

All 3 groups achieved significant improvement on postoperatively in BCVA (p < 0.01) and vitreous opacity (p < 0.01) compared with the baseline. The group difference was significant at the end of week 1 and showed a trend of higher IOP set at the end of PPV with better anatomical (p < 0.01) and visual recovery (p < 0.01). However, at postoperative month 1 and month 3, equivalent anatomical (month 1: p = 0.56; month 3: p = 0.36) and visual outcomes (month 1: p = 0.16; month 3: p = 0.88) were obtained in the 3 groups. The average effect of IOP on BCVA (group II versus group III: effect size (ES): 0.41, p < 0.01; group I versus group III: ES: 0.66, p < 0.01) and vitreous opacity (group II versus group III: ES: 0.70, p < 0.01; group I versus group III: ES:1.09, p < 0.01) over the course of the study period was statistically significant. The only postoperative complication was recurrent VH in two patients allocating in group I and II, respectively.

CONCLUSIONS

A relatively higher IOP set at the end of vitrectomy resulted in a more stable and rapid recovery with fewer complications in patients with non-complex VH.

Complications of vitreoretinal surgery

PURPOSE OF REVIEW

The present article reviews the most common and most serious vision-threatening and life-threatening complications of vitreoretinal surgery.

RECENT FINDINGS

Serious complications after vitreroretinal surgery are rare. Endophthalmitis for example has recently been estimated to occur in 0.08% of small gague vitrectomy. Other complications such as cataract are almost unavoidable, becoming visually significant in up to 80% of patients. The introduction of smaller gauge vitrectomy systems has reduced surgical times, conjunctival scarring and inflammation, and the rate of some complications such as retinal tears. Ocular venous air embolism is an exceedingly rare complication that is potentially life threating and therefore important for all vitreoretinal surgeons to be aware of.

SUMMARY

Though vitreoretinal surgery is well tolerated and effective, it is inevitable that all surgeons will experience complications and are therefore best served by understanding the potential complications, strategies to reduce the likelihood of them occurring, and ways to address them when they do happen.

Diathermy for 23-gauge sclerotomy: a functional and morphologic study to avoid ocular hypotony

Purpose

To evaluate diathermy to minimize sclerotomy leakage during small-gauge vitrectomy and prevent ocular hypotony.

Methods

This observational prospective study included 327 patients (327 eyes) who underwent diathermy to close the sclerotomy sites during 23-gauge pars plana vitrectomy (PPV). All patients were operated by a single surgeon (ED) and evaluated at 30 and 60 days postoperatively. Patients with glaucoma, topical/systemic steroids use exceeding 30 days, ocular inflammation, or trauma were excluded. Chi-square, Kruskal–Wallis, Fisher Exact test, and multivariate statistical analyses were performed to evaluate potential risk factors. The primary outcomes were open sclerotomies, leakage, and ocular hypotony.

Results

Sclerotomies remained open in 12 (3.6%) and 2 (0.6%) patients, respectively, at 30 and 60 days postoperatively, revealing no case of ocular hypotony. Leakage only occurred in four patients (1.2%) during week 1 postoperatively. Multivariate analysis indicated that additional vitreoretinal surgeries and longer surgeries were risk factors for persistent sclerotomy opening.

Conclusion

Diathermy was safe and feasible to close sclerotomies. Vitreoretinal surgery reoperations and longer surgeries were the most significant (P<0.05) risk factors for persistent sclerotomy opening, which may be functionally closed without evidence of leakage or ocular hypotony.

Comparative Analysis of Three-Dimensional Heads-Up Vitrectomy and Traditional Microscopic Vitrectomy for Vitreoretinal Diseases

Purpose: To investigate the visual outcomes and occurrences of perioperative complications after three-dimensional (3D) heads-up vitrectomy compared with traditional microscopic (TM) surgery for vitreoretinal diseases. Methods: A retrospective case series comparison of 3D and TM vitrectomy performed on 124 and 202 eyes with a minimum follow-up of 6 months, respectively, by the same surgeon. Changes in visual acuity, primary anatomical success, operation time, and perioperative complications were evaluated. Results: There were no significant differences in age, gender, axial length, ocular and surgical history, surgical indication, and visual acuity between the two groups at baseline. Both groups showed a significant improvement in visual acuity at the final visit (both P < .05) and experienced comparable anatomical recoveries regarding epiretinal membranes, vitreous hemorrhage, macular holes, retinal detachment, and pathological myopic foveoschisis. The mean overall operation time was not significantly longer in the 3D group (31.0 ± 17.6 min) than the TM (31.0 ± 15.9 min) group (P = .994). The incidence rates of postoperative complications during the follow-up were similar between the 3D (30.6%) and TM groups (30.2%) (P = .932). Conclusions: The 3D and TM vitrectomy surgeries yielded comparable visual and anatomical outcomes for treatment of vitreoretinal diseases without a significant difference in the rate of complications. The 3D heads-up vitrectomy may be considered the treatment of choice for patients with various vitreoretinal diseases.

Macular Hole in Myopic Eyes: A Narrative Review of the Current Surgical Techniques

Macular hole (MH) in myopic eyes is a disease arising from complex tractional forces exerted by vitreomacular interface, epiretinal tissue, and progressive scleral ectasia of the posterior ocular globe wall. This retinal disease requires vitreoretinal treatment for its repair, and the surgical intervention remains a challenge also for experienced surgeons. The aim of this review is to describe the current knowledge regarding the pathogenesis of MH in myopic eyes and to detail novel surgical techniques and technological advancements in its surgical management.

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.

Surgical timing and presence of a vitreoretinal fellow on postoperative adverse events following pars plana vitrectomy

INTRODUCTION

To evaluate the adverse event rate following pars plana vitrectomy as a function of surgical start time and the presence of a vitreoretinal fellow.

METHODS

Single-institution retrospective cohort study of patients undergoing pars plana vitrectomy from 1 January 2016 to 31 December 2016 at Stanford University School of Medicine (Palo Alto, CA, USA). Records were reviewed for surgical start time, the presence of vitreoretinal fellow, and postoperative adverse events defined as any finding deviating from the expected postoperative course requiring observation or intervention.

RESULTS

A total of 310 pars plana vitrectomies were performed. There was no statistical difference in the rate of any adverse event when comparing cases starting after 16:01 (9/13, 69.2%) and after 12:01 (42/99, 42.4%) to a morning start time (69/198, 34.9%, adjusted p = 0.083). There was a statistically significant increase in the risk of postoperative vitreous hemorrhage with afternoon and evening cases as compared to morning cases (adjusted p = 0.021). In addition, there was no difference in any adverse event with a fellow present (93/244, 38.1%) compared to without (27/66, 40.9%, adjusted p = 0.163). There was a higher risk of postoperative hypotony when a fellow was involved (6.6% vs 0%, p = 0.028), though this difference disappeared after adjusting for confounders (adjusted p = 0.252). There was no difference in the length of surgery with and without a fellow (49 vs 54 min, respectively; p = 0.990).

DISCUSSION

Afternoon start time and the presence of a fellow were not independent risk factors for postoperative adverse events.

Comparison of 23 Gauge Transconjunctival releasable Suture Vitrectomy with standard 20 gauge Vitrectomy

Objective:

To compare effectiveness of releasable transconjunctival sutures in 23 gauge vitrectomy and standard 20 gauge vitrectomy.

Methods:

This prospective comparative study was conducted in Department of Vitreoretinal Surgery, Al Ehsan Eye Hospital, Lahore from June 2016 to March 2017. It included 84 patients in total (Group-A: 42 patients underwent 23 gauge releasable suture vitrectomy; Group-B: 42 patients who underwent standard 20 gauge vitrectomy). Pre operative and post operative best corrected visual acuity, surgical duration, pre and post operative intraocular pressure and complication profile was compared between two groups.

Results:

The leading cause for vitrectomy was vitreous haemorrhage. (Group-A; n=15 ;35.71%; Group-B; n=17; 40.47%). There was statistically significant improvement in preoperative and postoperative BCVA in both groups (Group A: P-value < 0.05; Group B P-value < 0.05) but there was no significant difference in post operative BCVA between two groups at 3 months (P-value > 0.05). Surgical time for 23G vitrectomy Group was statistically less than 20 G vitrectomy Group (51 +/-18 minutes for Group-A versus 78 +/- 13 minutes for Group-B; p-value < 0.05). Visual analog score for pain / discomfort was also significantly less for Group-A than Group-B. There was no significant difference in intraocular pressures between the two groups.

Conclusions:

Releasable suture technique for small gauge vitrectomy is a safe and easily adaptable technique that has certain significant advantages over 20G absorbable suture vitrectomy.

Vitrectomy in high myopia: a narrative review

Pathologic myopia is associated with degenerative changes of the globe, especially at the posterior pole. Eyes affected by pathologic myopia have higher odds to undergo posterior segment surgery and, in those eyes, vitreoretinal surgery is challenging. Many practical tips and tricks can make the surgical procedures simpler, significantly preventing sight-threatening intra- and post-operative complications. Moreover, novel surgical techniques and technological advancements (i.e. ad-hoc instrumentation, minimally invasive vitreoretinal surgery, filters, dye staining, intraoperative optical coherence tomography and 3-dimensional surgery) may play role in highly myopic eyes. The aim of the present work is to review practical tips and tricks, novel surgical techniques and technological advancements.

Wet laboratory training using porcine eyes with eyelids

OBJECTIVE

This study aimed to evaluate the usefulness of a new wet laboratory (wet lab) system using porcine eyes with eyelids.

DESIGN

Teaching device trial.

PARTICIPANTS

Porcine eyes with orbital tissues and eyelids.

METHODS

Twenty porcine eyes with orbital tissues and eyelids were enucleated from pigs butchered at age 6 months. These eyes were positioned in the eye sockets of a model head and stabilized with a pin. Eye draping, dressing with tape, and speculum placement were conducted. The vertical and horizontal widths of the palpebra under the speculum setting were compared with those of 55 patients who underwent cataract surgery. The rotation and torsion of the porcine eye in the new wet lab system were also compared with those of a conventional wet lab system. For comparison with actual cataract surgery, 5 ophthalmologists, including residents, were asked to respond to a questionnaire survey.

RESULTS

The horizontal widths of the palpebra under the speculum setting were 27.5 ± 3.1 mm in porcine eyes and 28.6 ± 5.1 mm in human eyes, and the vertical widths were 16.9 ± 1.3 mm and 16.1 ± 1.5 mm (p = 0.53, 0.05). The amounts of rotation and torsion were significantly greater with the new wet lab system. Ophthalmologists evaluated the new wet lab system as being more realistic than the conventional system, in terms of both natural eye movement and restriction of the surgical field by the eyelid and the speculum.

CONCLUSIONS

Wet lab training using porcine eyes with eyelids is more practical than older systems as it reproduces an ocular surgical field very similar to that of humans.

Short- and Long-Term Outcomes of Vitreoretinal Surgeries With Deferred First Postoperative Visits at Day 3 or Later

Background and Objective:

Postoperative (PO) day 1 visits can be challenging for certain patients (eg, satellite office patients). This study analyzes the proportion of eyes requiring changes in management on the first PO visit day ≥3 following vitreoretinal surgery.

Study Design/Materials and Methods:

A retrospective, consecutive case series of 1 vitreoretinal surgeon was conducted on 246 surgeries of 231 patients with the first PO examination day ≥3 from January 1, 2008 to December 31, 2013. Clinical parameters were statistically analyzed to identify eyes with pressure issues or early interventions. Short- and long-term outcomes were assessed at PO weeks 1 to 4 and months 3 to 8.

Results:

At the first PO visit ≥3 (mean 4.5) days, 3.3% eyes had intraocular pressure (IOP) ≤5, 3.3% IOP ≥30, 0.8% choroidal detachments, 0.4% vitreous hemorrhage, and 0% endophthalmitis. About 2.0% of eyes required intervention (IOP medications). Surgical indications, procedure, and tamponade were not predictive of pressure issues or early intervention ( P > .05). At weeks 1 to 4 and month 3 to 8, 4% to 6% of eyes required additional intervention or surgery.

Conclusion:

The first PO visit day ≥3 after vitreoretinal surgeries had low intervention rates. Few complications or additional surgeries occurred throughout the study period.

Risk factors for suture requirement and early hypotony in 23-gauge vitrectomy for complex vitreoretinal diseases

PURPOSE

To find out the rate of suture requirement and post-operative hypotony in a series of 23-gauge pars plana vitrectomy cases and analyze the factors affecting post-operative hypotony and leakage of sclerotomy leading to suture placement.

METHODS

This is a single-center retrospective interventional case series. Eighty-four eyes underwent 23-gauge vitrectomy. Primary endpoint measures were rate of leakage of 23-gauge sclerotomies requiring suture placement at the end of surgery and rate of early post-operative hypotony. Secondary endpoint measures were risk factors for early hypotony and leakage requiring suture placement at the end of surgery.

RESULTS

Suture placement in at least one sclerotomy because of sclerotomy leakage was required in 28.6 % (24 of 84) of eyes at the end of surgery. Early post-operative hypotony was seen in 14.3 % (12 of 84). Silicone oil endotamponade and single-step surgery were found as factors increasing the risk of sclerotomy leakage leading to suture placement. Suture placement was the only significant factor increasing the risk of early post-operative hypotony.

CONCLUSION

Sclerotomy sutures may be required in 23-gauge surgery, more frequently in cases of single-step sclerotomy and/or silicone oil endotamponade. Meticulous suturation of leaking sclerotomies may decrease the rate of post-operative hypotony.

Refractive outcomes in nanophthalmic eyes after phacoemulsification and implantation of a high-refractive-power foldable intraocular lens

PURPOSE

To evaluate the refractive and postoperative outcomes of a high-power foldable intraocular lens (IOL) in nanophthalmic eyes.

SETTING

Six ophthalmic surgical centers in Canada.

DESIGN

Retrospective case series.

METHODS

Consecutive charts of nanophthalmic patients having cataract extraction and insertion of the CT Xtreme D IOL were reviewed. Demographic and clinical data were collected, including age, sex, axial length (AL), minimum keratometry (K) value and maximum K value, corneal white-to-white (WTW), anterior chamber depth, lens thickness (LT), and complications. The following preoperative and operative data were collected: uncorrected distant visual acuity (UDVA), corrected distant visual acuity (CDVA), sphere, cylinder, and spherical equivalence (SE). The primary outcome measure was change in SE. The secondary outcome measures were changes in UDVA and CDVA.

RESULTS

A total of 21 eyes from 13 patients with a mean follow-up time of 9.6 ± 8.5 months were studied. Mean preoperative data were: age (51.4 ± 15.2 years), AL (16.63 ± 0.68 mm), minimum K value (46.20 ± 2.26 D), maximum K value (47.55 ± 2.34 D), anterior chamber depth (2.60 ± 0.49 mm), WTW (11.08 ± 1.38 mm), LT (4.70 ± 0.97 mm), and IOL power implanted (+49.9 ± 3.3 diopters [D]). SE improved from +16.11 ± 3.26 D preoperatively to +2.00 ± 2.37 D postoperatively (P < .0001). UDVA improved from 1.47 ± 0.30 logMAR preoperatively to 0.74 ± 0.43 logMAR postoperatively (P = .016). CDVA did not change significantly. Five eyes (23.8%) had serious postoperative complications. Of these eyes, 2 had malignant glaucoma, 2 had vitreous hemorrhages, and 1 eye had a vitreous hemorrhage with retinal detachment resulting in visual acuity of no light perception.

CONCLUSION

Implanting foldable high-power IOLs in a series of nanophthalmic eyes yielded significant improvement in UDVA and SE. Cataract surgery in these eyes carries increased risk.

FINANCIAL DISCLOSURE

Iqbal Ike K. Ahmed is a consultant to Carl Zeiss Meditec AG. No other author has a financial or proprietary interest in any material or method mentioned.

The Incidence of Rhegmatogenous Retinal Complications in Macular Surgery After Prophylactic Preoperative Laser Retinopexy: A Retrospective Study

The aim of the study is to evaluate the clinical characteristics of intraoperative retinal breaks (RBs) and postoperative retinal detachment (RRD) in patients undergoing pars plana vitrectomy (PPV) for macular disorders, who were treated preoperatively with prophylactic peripheral laser retinopexy.This observational cohort study comprised of 254 patients who underwent macular surgery and were preoperatively subjected to prophylactic laser retinopexy anterior to the equator. The main outcome measures were the incidence and characteristics of intraoperative RBs and postoperative RRD.Intraoperative RBs occurred in 14 patients (5.5%). Ten patients presented a sclerotomy-related RB (3.9%) and 4 patients a nonsclerotomy-related RB (1.6%). Two patients showed postoperative RRD (0.7%). Neither of the 2 patients with postoperative RRD was macula-off at presentation: one of them was successfully operated on with scleral buckling and the other was managed by observation alone. A significantly increased risk for the intraoperative development of sclerotomy-related RB was found in 20-gauge PPV compared with 23/25-gauge PPV.Preoperative prophylactic peripheral laser retinopexy does not guarantee the prevention of intraopertaive RBs or postoperative RRD. However, it might prevent the involvement of the macula when RRD occurs postoperatively.

Evaluation of mechanical closure resistance of sutureless vitrectomy sclerotomies after conjunctival cauterization with bipolar diathermy forceps

BACKGROUND

Suturing is the most widely used technique to close leaking sclerotomies after transconjunctival sutureless vitrectomy (TSV). However, with the aim of avoiding the disadvantages caused by conjunctival stitches, there have been described other closure techniques, such as the cauterization of the conjunctiva placed over the incisions. To continue advancing knowledge of the incisional occlusion effect achieved by conjunctival diathermy, it would be also interesting to study the wound closure resistance obtained under intraocular pressure (IOP) changes, given that in the early postoperative period eyes are subjected to pressure stress. In our study, we compare the mechanical resistance observed in sclerotomies treated with bipolar diathermy after TSV compared to that found in incisions in which cauterization was not performed.

METHODS

This was an experimental, randomized, and observer-masked study in which 23-gauge TSV was performed in 80 cadaveric pig eyes. Once each vitrectomy was finished, cauterization was performed with bipolar diathermy forceps on the conjunctiva placed over one of the superior sclerotomy sites; no maneuver was performed over the other superior incision. IOP was gradually increased by means of the vitrectomy system (Accurus; Alcon Laboratories, TX) until one of the superior sclerotomies opened, allowing internal ocular solution to escape.

RESULTS

In 35 % of cases (28 of 80 eyes), sclerotomies subjected to diathermy allowed intraocular fluid escape first (p = 0.01). When comparing opening pressure values, cauterized incisions leaked at significantly higher pressure levels than those in which diathermy was not applied (p < 0.001).

CONCLUSIONS

Bipolar diathermy on sutureless sclerotomies has demonstrated to be, in our experimental model, an effective method for increasing the sclerotomy closure resistance. Although its use in vitrectomized eyes has previously been described, our study is the first to analyze the response of cauterized sclerotomies to IOP increases.

Influence of silicone oil tamponade on self-sealing sclerotomy using 25-gauge transconjunctival sutureless vitrectomy: a retrospective comparative study

Background

Characteristic complications have been reported for transconjunctival sutureless vitrectomy, such as postoperative sclerotomy leakage and postoperative hypotony. Particular attention to sclerotomy closure is required in cases of silicone oil tamponade, because postoperative supplementation of silicone oil implies reoperation, whereas postoperative supplement of gas is comparatively easy. This study investigated sclerotomy closure in cases of silicone oil tamponade using 25-gauge transconjunctival sutureless vitrectomy.

Methods

We enrolled 19 consecutive eyes with silicone oil injection (Group A, self-sealing sclerotomies, n = 10) (Group B, sutured sclerotomies, n = 9) and 10 eyes with silicone oil removal (Group C, self-sealing sclerotomies) using 25-gauge TSV. Postoperative intraocular pressure was compared between Groups A and B, and between Groups A and C using repeated-measures analysis of variance (ANOVA), one-way factorial ANOVA, and the Tukey-Kramer test.

Results

No significant differences in age or axial length were seen among groups, but surgical time differed significantly between Group C and the other groups. Mean duration of silicone oil tamponade was 3.2 ± 1.4 months in Group C, and no sclerotomies in Group A or C required suture placement. Postoperative silicone oil leakage to the subconjunctival space was not encountered in Group A. No cases showed postoperative hypotony (defined as intraocular pressure <5 mmHg). Significant differences in intraocular pressure within the same postoperative period were not identified between Groups A and B. Conversely, significant differences in intraocular pressure within the same postoperative period were identified at postoperative days 1 and 2, although not at postoperative week 1 or postoperative month 1 between Groups A and C.

Conclusions

The procedure for sclerotomy closure seems to have little influence on postoperative intraocular pressure in eyes with silicone oil tamponade using 25-gauge transconjunctival sutureless vitrectomy, because silicone oil tamponade may avoid postoperative hypotony by decreasing sclerotomy leakage in the early postoperative period.

Electronic supplementary material

The online version of this article (doi:10.1186/s12886-015-0159-z) contains supplementary material, which is available to authorized users.

Factors influencing self-sealing of sclerotomy performed under gas tamponade in 23-gauge transconjunctival sutureless vitrectomy

Background

The purpose of this study was to investigate factors influencing self-sealing of sclerotomy performed under gas tamponade in 23-gauge transconjunctival sutureless vitrectomy.

Methods

This study was a retrospective review of 84 patients (84 eyes) who underwent 23-gauge transconjunctival sutureless vitrectomy under gas tamponade by a single surgeon. At the end of surgery, the sclerotomy was massaged to promote self-sealing. Factors influencing massage time were examined using multiple regression analysis. Independent variables were age, surgical time, vitreous incarceration, intraocular manipulation, and axial length.

Results

Significant factors were intraocular manipulation and vitreous incarceration in the examination of all sclerotomies, age only in the examination of infusion sites, and vitreous incarceration only in the examination of manipulation sites.

Conclusion

In sclerotomy performed with gas tamponade using 23-gauge transconjunctival sutureless vitrectomy, intraocular manipulation influenced self-sealing of sclerotomy the most, followed by vitreous incarceration, and then age.

Rate of sclerotomy suturing in 23-gauge primary vitrectomy

PURPOSE

To evaluate the rate of sclerotomy suturing in a large series of primary 23-gauge vitrectomies.

METHODS

Retrospective chart review of 23-gauge transconjunctival pars plana vitrectomies performed between 2008 and 2012 in a multisurgeon retina practice. Patients with a history of retinal surgery, combination of vitrectomy and scleral buckling surgery, or intraoperative conversion of a sclerotomy to 20-gauge were excluded from the study. Vitrectomies were divided into two types according to their degree of complexity and intraoperative use of instrumentation. Demographic and clinical data were gathered from the chart. Location and number of sutured sclerotomies were obtained from the operative report.

RESULTS

A total of 589 eyes from 569 patients were included in this study. At least 1 sclerotomy was sutured in 227 eyes (38.5%): 69 (30.4%) had 1 sutured sclerotomy, 52 (22.9%) had 2 sutured sclerotomies, and 106 (46.7%) had 3 sutured sclerotomies. Sclerotomy suturing was significantly related to the surgical technique (P < 0.001), type of tamponade agent (P = 0.048), and complexity of the vitrectomy (P < 0.001). The incidence of postoperative hypotony at Day 1 was 2.2% and all cases returned to normal intraocular pressure at 1 week. There were no recognized complications related to sclerotomies regardless of suturing.

CONCLUSION

The factors that increased the rate of sclerotomy suturing were the absence of tamponade agent and higher complexity of the procedure. There was a high variability in the rate of suturing between the surgeons.

Recovery of visual function after administration of dabigatran etexilate

A 46-year-old Caucasian female underwent pars plana vitrectomy (ppv) for retinal detachment. After the procedure, the patient could only distinguish hand movements; the condition was tentatively diagnosed as nonarteritic anterior ischemic optic neuropathy. Conventional treatment with systemic corticosteroids and acetylsalicylic acid was ineffective and yielded substantial steroid-related side effects. Additional administration of 2 × 110 mg dabigatran etexilate (Pradaxa(®)), a novel direct thrombin inhibitor, resulted in a prompt and marked improvement of visual acuity, which indicated improved blood flow in the central vessels of the optic nerve. Dabigatran etexilate may provide a promising alternative for the treatment of postprocedural vision loss after ppv.

Examination of Self-Sealing Sclerotomy for Vitrectomized Eye under Gas Tamponade in 23-Gauge Transconjunctival Sutureless Vitrectomy

INTRODUCTION

To investigate whether a previous history of vitrectomy affects sclerotomy self-sealing under gas tamponade in 23-gauge transconjunctival sutureless vitrectomy.

MATERIALS AND METHODS

This study retrospectively reviewed two groups, a vitrectomized group (seven consecutive cases) and an initial vitrectomy group (82 consecutive cases), who underwent 23-gauge transconjunctival sutureless vitrectomy at Jikei University School of Medicine Daisan Hospital in Tokyo. Factors affecting sclerotomy self-sealing were examined using multiple regression analysis. The criterion variable was massage time, and independent variables were age, surgical time, axial length, vitreous incarceration, history of vitrectomy, preoperative intraocular pressure (IOP), and postoperative IOP.

RESULTS

Age (F = 10.4) was the only significant factor. History of vitrectomy was not a significant factor (F = 0.06).

CONCLUSIONS

Previous history of vitrectomy does not affect sclerotomy self-sealing under gas tamponade in 23-gauge transconjunctival sutureless vitrectomy.

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.

Long-term hypotony because of accidental break of a 23 g microcannula after transconjunctival sutureless vitrectomy

PURPOSE

To report a case of long-lasting hypotony because of accidental break, with scleral tunnel entrapment, of a 23-gauge microcannula during transconjunctival sutureless vitrectomy.

METHODS

Interventional case report. An 80-year-old Spanish woman who underwent 23-gauge transconjunctival sutureless vitrectomy presented at the postoperative ocular examination with irreversible, refractory low intraocular pressure of unknown cause. Two weeks after surgery, a piece of the microcannula was found at the inferotemporal sclerotomy site during a scheduled medical appointment. Surgical intervention was indicated to explore and remove the foreign body.

RESULTS

The day after foreign body extraction, the patient's pressure rose to normal levels. However, her visual acuity did not improve until 3 weeks later.

CONCLUSION

Transient postoperative hypotony is unsurprising after 23-gauge vitrectomy because of leakage of small-diameter open sclerotomies. However, when long-term low intraocular pressure fails to return to normal levels because of an unidentified condition, breaking of the microcannula piece with scleral tunnel entrapment may be contemplated.

Diathermy of leaking sclerotomies after 23-gauge transconjunctival pars plana vitrectomy: a prospective study

PURPOSE

To evaluate the efficacy of bipolar diathermy in ensuring closure of leaking sclerotomies after complete 23-gauge transconjunctival sutureless vitrectomy.

METHODS

In this prospective, interventional case series, in 136 eyes of 136 patients with at least one leaking sclerotomy at the end of a complete 23-gauge transconjunctival sutureless vitrectomy, external bipolar wet-field diathermy was applied to leaking sclerotomies, including the conjunctiva and sclera. Intraoperative wound closure, and postoperatively, at 6 hours, 1 day and 3 days, sclerotomies leakage, intraocular pressure, hypotony, and hypotony-related complications were evaluated.

RESULTS

Intraoperative closure was achieved in 231 of 238 leaking sclerotomies (97%) that received diathermy. One of these with postoperative leakage needed suture. Compared with baseline (14.4 ± 2.8 mmHg), mean intraocular pressure was lower at 6 hours (13.2 ± 3.8 mmHg, Tukey-Kramer P < 0.001) and not different at 24 hours or 72 hours. Hypotony (intraocular pressure <5 mmHg) was observed in 6 eyes (4.5%) at 6 hours, in 2 (1.5%) at 24 hours, and in none at 3 days. Logistic regression analysis showed that, 6 hours postoperatively, hypotony was related to younger age (≤50 years) at surgery (P = 0.031). No hypotony-related complications were recorded.

CONCLUSION

Bipolar wet-field diathermy of sutureless sclerotomies is an effective method for ensuring a leaking sclerotomies closure.

Safety of 20-gauge transconjunctival sutureless vitrectomy

PURPOSE

To study the safety of 20-gauge transconjunctival sutureless vitrectomy.

METHODS

Clinical data of patients who underwent 20-gauge transconjunctival sutureless vitrectomy for the first time, for various disorders, were reviewed retrospectively. The main outcome measures were the number of sclerotomies requiring suturing as well as the intra- and postoperative complications.

RESULTS

A total of 179 operations were performed. Indications for vitrectomy included 68 idiopathic epiretinal membranes, 26 macular holes, 23 phakic and 16 pseudophakic retinal detachments, and 46 various other, less common etiologies. Of these 179 operations, 166 (93%) were sutureless. Of the 537 sclerotomies created, 25 (5%) received a single transconjunctival-scleral suture. Intraoperative complications included premature dislodging of the cannulas in 2 sclerotomies and an iatrogenic horseshoe tear at 1 sclerotomy site. Postoperative complications comprised transient hypotony in 14 cases, subconjunctival gas in 2 cases, and choroidal effusion in 1 case. No serious complications (such as endophthalmitis) were observed.

CONCLUSION

20-gauge transconjunctival sutureless vitrectomy can be considered safe, as the intra- and postoperative complications observed are neither numerous nor significant. Sclerotomies appear to be safe and relatively easy to perform, without compromising the advantages of sutureless surgery.

Changes in day 1 post-operative intraocular pressure following sutureless 23-gauge and conventional 20-gauge pars plana vitrectomy

Background/Aims:

The benefits associated with transconjunctival sutureless vitrectomy techniques are continuing to be defined. The purpose of this study was to compare the incidence of extreme changes in day 1 intraocular pressure (IOP) following 23-gauge sutureless vitrectomy compared with conventional 20-gauge vitrectomy.

Methods:

Fifty consecutive 23-gauge and 50 consecutive 20-gauge cases were included; eyes with a history of previous vitreoretinal surgery were excluded. 23-gauge surgery was completed with passive fluid air exchange where no long acting tamponade was indicated. The surgery remained sutureless unless a leak was visible at the end of the procedure. Data were collected by retrospective case note review. Statistical analysis was carried out using Fisher’s exact and chi-square tests.

Results:

Twenty-two percent (11/50) of 23-gauge vitrectomies required suturing of one or more ports. On the first post-operative day hypotony (IOP<5mmHg) occurred in 1/50 eyes in the 20- and 23-gauge groups. Raised pressure (IOP>21mmHg) occurred in 30% (15/50) of eyes in the 20-gauge group and 8% (4/50) of eyes in the 23-gauge group; IOP>30mmHg only occurred in the 20-gauge group (3/50).

Conclusion:

Fluid air exchange following 23-gauge vitrectomy is associated with very low risk of day 1 hypotony. This predominantly sutureless technique appears to reduce the incidence and magnitude of early post-operative IOP elevation compared with conventional 20-gauge vitrectomy.

Twenty-five-gauge vitrectomy versus 23-gauge vitrectomy in the management of macular diseases: a comparative analysis through a Health Technology Assessment model

Small-gauge vitreoretinal techniques have been shown to be safe and effective in the management of a wide spectrum of vitreoretinal diseases. However, the costs of the new technologies may represent a critical issue for national health systems. The aim of the study is to plan a Health Technology Assessment (HTA) by performing a comparative analysis between the 23- and 25-gauge techniques in the management of macular diseases (epiretinal membranes, macular holes, vitreo-macular traction syndrome). In this prospective study, 45-80-year-old patients undergoing vitrectomy surgery for macular disease were enrolled at the Torino Eye Hospital. In the HTA model we assessed the safety, clinical effectiveness, and cost and financial evaluation of 23-gauge compared with 25-gauge vitrectomies. Fifty patients entered the study; 14 patients underwent 23-gauge vitrectomy and 36 underwent 25-gauge vitrectomy. There was no statistically significant difference in post-operative visual acuity at 1 year between the two groups. No cases of retinal detachment or endophtalmitis were registered at 1-year follow-up. The 23-gauge technique was slightly more expensive than the 25-gauge: the total surgical costs were EUR1217.70 versus EUR1164.84 (p = 0.351). We provide a financial comparison between new vitreoretinal procedures recently introduced in the market and reimbursed by the Italian National Health System and we also stimulate a critical debate about the expensive technocratic model of medicine.

Comparison of the 20-gauge conventional vitrectomy technique with the 23-gauge releasable suture vitrectomy technique

PURPOSE

To compare the efficacy of the transconjunctival releasable suture technique for pars plana vitrectomy using 23-gauge (23G) instruments versus the conventional 20-gauge (20G) technique.

METHODS

A retrospective and interventional case series was consecutively performed for 199 eyes of the 192 patients that were a part of this study. Clinical data were reviewed retrospectively regarding the operation time, preoperative and postoperative intraocular pressure, visual acuity and astigmatism for 54 consecutive patients who received a 23G releasable suture vitrectomy and for 98 consecutive patients who received a 20G conventional vitrectomy during the period between April 2007 and September 2010.

RESULTS

Mean operation time based on the operation record was 88.5 ± 20.1 minutes in the 23G releasable suture vitrectomy group and 102.1 ± 23.1 minutes in the 20G conventional vitrectomy group, respectively (p = 0.01). The last best-corrected visual acuity (BCVA) was significantly better than the preoperative BCVA in both patient groups (p = 0.01, p = 0.01). The 23G releasable suture group showed less surgically induced astigmatism than the 20G conventional vitrectomy group. Vitreous bleeding was observed to be in 6 eyes (5.9%) in the 23G group, and in 8 eyes (8.2%) in the 20G group. In addition, ocular hypertension was noted to be in 3 eyes (3.0%) in the 23G group, and 6 eyes (6.1%) in the 20G group. No serious complications such as postoperative hypotony or endophthalmitis were observed in either group.

CONCLUSIONS

The 23G releasable suture technique is as effective as the 20G conventional technique and offers several advantages.

Clinical presentation of a mixed 23-gauge infusion and 20-gauge pars plana technique for active silicone oil removal

AIM

To present with a clinical case series of a mixed 23-gauge infusion and 20-gauge pars plana technique for 5,700-centipoise silicone oil removal (SOR), and to discuss its efficacy and safety.

METHODS

This is a retrospective, non-randomized controlled study. We performed SOR with 23-gauge infusion and 20-gauge active suction technique on 29 patients 29 eyes from April to October, 2011 (mixed group). During the surgeries, a 23-gauge sclerotomy was made for infusion and a 20-gauge sclerotomy was used for active silicone oil suction. Anterior segment optical coherence tomography (OCT) was applied for 23-gauge sclerotomy analysis 1 day post-operation. Traditional 20-gauge SOR was performed on another consecutive 29 patients 29 eyes, the control group (20G group).

RESULTS

There were 2 eyes (6.9%) in mixed group and 5 eyes (17.2%) in 20G group which had recurrent retinal detachment after surgery. Hopytony (IOP≤6mmHg) occurred in 8 eyes (27.6%) of mixed group and in 10 eyes (34.5%) of 20G group post-operation, but all of them recovered to the normal level finally. There were no statistical significant differences. Final visual acuity was significantly increased after surgery in both groups. Anterior segment OCT images were acquired from 13 eyes of mixed group, and all of them had a proper wound apposition. But local ciliary detachment was found in 9 eyes (69%). It was hard to define the OCT image of the sclerotomies and ciliary body because of the serious conjunctival hemorrhages and chemosis in 20G group.

CONCLUSION

This mixed technique is a convenient and effective way to remove high viscosity silicone oil. Compared with traditional 20-gauge SOR, it does not increase the risk of post-operative complications and has less conjunctival reactions.. Transient postoperative hypotony is common for this procedure and subclinical ciliochoroidal detachment is a probable cause.

The 1-year incidence of rhegmatogenous retinal detachment post 23-gauge pars plana vitrectomy

OBJECTIVE

The purpose of this study was to evaluate the 1-year incidence of retinal tear or retinal detachment following 23-gauge pars plana vitrectomy (PPV) for epiretinal membrane (ERM), macular hole (MH), or vitreomacular traction (VMT).

METHODS

A retrospective chart review of all patients who underwent 23-gauge PPV for ERM, MH, or VMT between January 1, 2007, and December 31, 2007, was performed. Inclusion criteria included age greater than 50 years and absence of other significant ocular pathology. Exclusion criteria included confounding retinal pathology, laser treatment at the time of surgery, previous laser treatment of the retina, or previous PPV.

RESULTS

A total of 272 eyes of 268 patients were eligible for inclusion: 159 eyes (58%) had the diagnosis of ERM; 108 (40%) had MH; and 5 (2%) had VMT. The average patient age was 70 years. Of the patients, 15 required additional surgery related to persistent macular pathology within 1 year (5 with ERM, 10 with MH). The incidence of retinal detachment after surgery was 1.1% (3 eyes of 3 patients). The mean time duration prior to development of retinal detachment was 159 days (range, 19 to 333 days).

CONCLUSIONS

The 1-year incidence of rhegmatogenous retinal detachment post 23-gauge vitrectomy for repair of macular pathology without prophylactic laser of sclerotomy sites is approximately 1%.

Primary 23-gauge vitreoretinal surgery for rhegmatogenous retinal detachment

AIM

To report the effectiveness and safety of primary 23-Gauge (G) vitreoretinal surgery for rhegmatogenous retinal detachment (RRD).

METHODS

In this retrospective study, 49 eyes of 49 consecutive patients who underwent primary 23-G transconjunctival sutureless vitrectomy (TSV) for RRD between January 2007 and July 2009 at our institution were evaluated.

RESULTS

Mean follow-up time was 8.9±7.7 months (1-28 months). Retinal reattachment was achieved with a single operation in 47(95.9%) of 49 eyes. In two eyes (4.1%), retinal redetachment due to new breaks was successfully treated with reoperation using the 23-G TSV system. Mean logMAR visual acuity was 2.01±0.47 preoperatively and 1.3±0.5 postoperatively (P<0.001, Paired t-test). Mean preoperative intraocular pressure (IOP) was 14.1±2.8mmHg. Mean postoperative IOP was 12.3±3.6mmHg at 1 day, 13.1±2.1mmHg at 1 week, 14.3±2.2mmHg at 1 month. Iatrogenic peripheral retinal break was observed in 1 eye (2.0%) intraoperatively. No sutures were required to close the scleral or conjunctival openings, and no eyes required convertion of surgery to 20-G vitrectomy.

CONCLUSION

Primary 23-G TSV system was observed to be effective and safe in the treatment of RRD.

The incidence and distribution of iatrogenic retinal tears in 20-gauge and 23-gauge vitrectomy

PURPOSE

The development of 23-gauge vitrectomy surgery has many benefits including a reduction in surgical time and faster postoperative rehabilitation; however, some have suggested that the complication rate is higher. To assess this we compared the incidence and distribution of iatrogenic retinal tears in 20- and 23-gauge surgery.

METHODS

Fifty consecutive 23-gauge and 50 consecutive 20-gauge vitrectomy cases were selected; eyes with a history of previous vitreoretinal surgery were excluded. All surgery was performed by two surgeons (JL and RN). Entry-site breaks (ESB) were defined as any new vitreoretinal abnormality occurring within 1 clock hour of an entry site for which treatment with cryotherapy was deemed necessary. Data were collected by retrospective case note review. Statistical analysis was carried out using Fisher's exact and χ(2)-tests.

RESULTS

ESB occurred in 24% (12/50) of cases in the 20-gauge group compared with 8% (4/50) in the 23-gauge group (P = 0.03); 88% (14/16) occurred superiorly on the same side as the surgeons' dominant hand. Iatrogenic breaks recorded elsewhere indicated an increased incidence in the 20-gauge group (9/50 compared with 6/50 in 23-gauge) but this did not achieve significance; the most common position was at 6 o'clock.

CONCLUSIONS

23-Gauge vitrectomy is associated with significantly fewer ESB when compared with conventional 20-gauge vitrectomy. The incidence of other iatrogenic breaks did not appear to be significantly different between the two groups.

[Sutureless transconjunctival 20-gauge vitrectomy]

PURPOSE

To evaluate the safety and efficacy of 20-gauge transconjunctival sutureless vitrectomy for a variety of vitreoretinal conditions.

PATIENTS AND METHODS

This study was a retrospective clinical case series examining 29 eyes of 29 patients treated with 20-gauge transconjunctival sutureless vitrectomy. The main outcome measures included intraocular pressure, visual acuity, surgical time, and intraoperative and postoperative complications.

RESULTS

The mean follow-up duration was 5.7 months. There were only two cases of postoperative ocular hypotony (6.9%) and one suspect case of endophthalmitis. Mean overall acuity improved from 0.495 logMar at baseline to 0.29 logMar (p=0.002) and mean total operative time was 19 min. We observed no cases of retinal detachment.

CONCLUSION

Twenty-gauge transconjunctival sutureless vitrectomy is an effective surgical technique, but other studies are needed to confirm its safety and its value in other indications.