Comparative Study of 27-Gauge versus 25-Gauge Vitrectomy for the Treatment of Primary Rhegmatogenous Retinal Detachment

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

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

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.

27‑Gauge vitrectomy vs. 25‑gauge vitrectomy in the management of proliferative diabetic retinopathy with preoperative intravitreal injection of conbercept

Small-gauge vitrectomy has become popular due to its notable advantages, including less trauma, shortened convalescence and improved manoeuvrability. The aim of the present study was to compare the surgical outcomes of 27-gauge (27-G) vitrectomy with those of 25-gauge (25-G) vitrectomy in the management of proliferative diabetic retinopathy (PDR) with preoperative intravitreal injection of conbercept. The data of 48 consecutive patients with PDR (48 eyes) were retrospectively collected. The patients underwent conbercept intravitreal injection and pars plana vitrectomy with a 27-G group (23 eyes) or 25-G group (25 eyes) vitrectomy system. The operating time, suturing rate, endodiathermy rate, postoperative best-corrected visual acuity (BCVA), intraocular pressure (IOP) and complications were recorded. The mean postoperative BCVA at final follow-up was significantly improved compared with that at the baseline in both groups (P<0.001 for both). The differences in the mean BCVA changes between the two groups were not significant (P>0.99), and no differences were observed in the final central foveal thickness (P=0.51) between the two groups. The final IOP remained stable compared with that at the baseline in the 27-G group (P=0.36) and the 25-G group (P=0.05). The suturing rate was significantly decreased in the 27-G group compared with the 25-G group (P=0.04). There were no significant differences between the two groups in terms of the operating time (P=0.18), rate of endodiathermy use (P>0.99), iatrogenic retinal breaks (P=0.42) or postoperative recurrent vitreous haemorrhage (P>0.99). In addition, no case of ocular hypotony was observed in either group. In conclusion, 27-G vitrectomy was as efficient and safe as 25-G vitrectomy in the management of PDR in terms of operating time and complications. With reference to the literature, preoperative conbercept injection appears to assist in decreasing the incidence of intraoperative and postoperative complications.

27-gauge microincision vitrectomy surgery compared with 25-gauge microincision vitrectomy surgery on wound closure and need for wound suture and other postoperative parameters in the treatment of vitreoretinal disease: A meta-analysis

We performed a meta-analysis to evaluate the effect of 27-gauge microincision vitrectomy surgery compared with 25-gauge microincision vitrectomy surgery on wound closure and the need for wound suture and other postoperative parameters in the treatment of vitreoretinal disease. A systematic literature search up to June 2022 was performed and 1264 subjects with the vitreoretinal disease at the baseline of the studies; 562 of them were using the 27-gauge microincision vitrectomy surgery, and 722 were using 25-gauge microincision vitrectomy surgery. Odds ratio (OR), and mean difference (MD) with 95% confidence intervals (CIs) were calculated to assess the effect of 27-gauge microincision vitrectomy surgery compared with 25-gauge microincision vitrectomy surgery on wound closure and the need for wound suture and other postoperative parameters in the treatment of vitreoretinal disease using the dichotomous, and contentious methods with a random or fixed-effect model. The 27-gauge microincision vitrectomy surgery subjects had a significantly lower intraoperative and postoperative wound complication (OR, 6.66; 95% CI, 0.46-0.95, P = .02), and wound suture number (OR, 0.38; 95% CI, 0.20-0.71, P = .002), and best corrected visual acuity (MD, -0.03; 95% CI, -0.05 to -0.001, P = .02) compared with 25-gauge microincision vitrectomy surgery in subjects with vitreoretinal disease. However, 27-gauge microincision vitrectomy surgery subjects had no significant difference in the wound closure time (MD, -8.45; 95% CI, -23.44 to 6.55, P = .27), operation time (MD, 0.85; 95% CI, -1.17 to 2.86, P = .41), intraocular pressure at postoperative day 1 (MD, 0.42; 95% CI, -1.45-2.28, P = .66), primary anatomical success rate (OR, 0.83; 95% CI, 0.42-1.63, P = .58), and central macular thickness (MD, 1.81; 95% CI, -21.76 to 25.37, P = .88) compared to 25-gauge microincision vitrectomy surgery in subjects with vitreoretinal disease. The 27-gauge microincision vitrectomy surgery subjects had a significantly lower intraoperative and postoperative wound complication, wound suture number, and best corrected visual acuity, and no significant difference in the wound closure time, operation time, intraocular pressure at postoperative day 1, primary anatomical success rate, and central macular thickness compared to 25-gauge microincision vitrectomy surgery in subjects with vitreoretinal disease. The analysis of outcomes should be with caution because of the low sample size of 12 out of 15 studies in the meta-analysis and a low number of studies in certain comparisons.

The Clinical and Safety Outcomes of 27 Gauge Pars Plana Vitrectomy in Eyes With Macular Hole

Objective To report the clinical, visual, and safety outcomes of 27 gauge pars plana vitrectomy (27G PPV) in eyes with full thickness and lamellar macular hole (MH).  Methodology This retrospective cross-sectional study, conducted at the ophthalmology department of Shifa International Hospital, Islamabad, was done on 89 eyes of 85 patients who underwent 27G PPV for full-thickness and lamellar MH with a postoperative follow-up period of six months.  Results The mean age was 61.9 ± 17.3 years with 57.3% being males. Most of the eyes had idiopathic stage III full-thickness MH (n=34, 38.2 %). The total mean operating time was 42.5 ± 19.8 minutes. During surgery, 48 (53.9%) eyes had concurrent phacoemulsification. Hexafluoroethane was the most commonly used tamponade agent (n=81, 91%). Postoperatively, the primary closure rate was 93.2% (n=83) while the final closure rate was 100% (n=6) either by prolonged posturing (n=3, 3.3%) or by an additional procedure involving autologous internal limiting membrane (ILM) transplant (n=3, 3.3%). The complication rate was 2.2% including iatrogenic retinal tear (n=1, 1.1%) and raised IOP (n=1, 1.1%). The overall best-corrected visual acuity (BCVA) improved significantly from 1.20 ± 0.67 to 0.31 ±0.17 (p=<0.001). Conclusion As per this study, 27G PPV is a practical and efficient surgical system with substantial anatomical success, minimal complication, and considerable visual recovery rates in eyes with full thickness and lamellar MH. We suggest 27G PPV with ILM peeling and medium-acting intraocular gas as the standard procedure for MH.

Clinical outcomes of a beveled tip, ultra-high speed, 25-gauge pars plana vitrectomy system

Objective

To report the clinical outcomes of a 25-gauge, beveled-tip, 10,000 cuts-per-minute (cpm) microincisional vitrectomy surgery (MIVS) system.

Methods

Prospective case series of eyes undergoing primary pars plana vitrectomy (PPV) for common vitreoretinal indications. Main outcome measures were: rate of achieving surgical objectives, operative times, number of surgical steps, use of ancillary instruments, corrected distance visual acuity (CDVA), and adverse events (AE).

Results

The surgical objectives were achieved in all eyes. Mean total operative time (TOT), core, shave and total vitrectomy times were 1891 ± 890, 204 ± 120, 330 ± 320, 534 ± 389 s, respectively. Mean number of surgical steps was 4.3 ± 1.5. Mean number of ancillary instruments used was 4.5 ± 1.9. Mean CDVA improved by 0.53 ± 0.56 logMAR units (P < 0.001) 3 months postoperatively. AE included elevated IOP (8%), hypotony (6%), and re-detachment (2%). Majority (82%) had no postoperative discomfort. The number of surgical steps demonstrated a positive correlation with TOT (p < 0.05), number of ancillary instruments used (p < 0.05), and postoperative Day 1 IOP (p < 0.05). The number of times ancillary instrumentation was used demonstrated a positive correlation with TOT (p < 0.05).

Conclusion

Beveled-tip, 10,000 cpm MIVS system effectively and safely performs common VR procedures of varying complexity and may reduce operative times and use of ancillary instrumentation.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12886-022-02311-3.

Comparison of 27-gauge and 25-gauge vitrectomy in the management of tractional retinal detachment secondary to proliferative diabetic retinopathy

OBJECTIVE

To compare surgical outcomes between 27 and 25-gauge vitrectomy in proliferative diabetic retinopathy (PDR) with tractional retinal detachment (TRD).

METHODS

This retrospective study was conducted to compare the intraoperative status, operation time, use of instruments, endotamponade substance, wound suture number, and iatrogenic break, between 27 and 25-gauge vitrectomy in 43 eyes afflicted by PDR with TRD. The post-surgical results, best-corrected visual acuity, intraocular pressure, recurrent vitreous haemorrhage, and re-operation rate were regularly followed up for 6 months.

RESULTS

Patients in the 25 and the 27-gauge groups did not differ significantly in terms of pre-surgical conditions, such as age, gender, pre-existing glaucoma, best-corrected visual acuity (BCVA) and the severity of their TRD. The mean operation time was 56.7 minutes in the 27-gauge group and 63.7 minutes in the 25-gauge group (p = 0.94). There is significantly less use of micro forceps in the 27-gauge group (p = 0.004). No difference between micro scissors and chandelier usage were noted; neither was their difference in iatrogenic retinal breaks. Significantly fewer wound sutures were noted in the 27-gauge group (p < 0.001). The post-operative results revealed no significant difference in ocular hypertension, hypotony, BCVA improvement, recurrent vitreous haemorrhage and re-operation rate.

CONCLUSIONS

The 27-gauge vitrectomy system offers comparable surgical outcomes in PDR with TRD. The 27-gauge vitrectomy system is suitable for complicated retinal surgery.

FLOW DYNAMICS OF BEVELED-TIP AND FLAT-TIP VITREOUS CUTTERS

PURPOSE

To compare the flow dynamics of beveled-tip to that of flat-tip vitreous cutters.

METHOD

The aspiration rates of balanced salt solution and swine vitreous were measured for 25-gauge and 27-gauge beveled-tip and flat-tip vitreous cutters. Fluorescent polymer microspheres were mixed with balanced salt solution to make the flow visible. The flow dynamics at maximal cutting rates and reflux of balanced salt solution were measured with video images of a high-speed camera.

RESULTS

The aspiration rates of balanced salt solution of the 25-gauge and 27-gauge beveled-tip cutters were significantly higher than that of the flat-tip cutters at 7,500 cut/min (P = 0.0001, P = 0.038, respectively). The aspiration rate of swine vitreous by the 25-gauge beveled-tip cutter was significantly higher than that of the flat-tip cutters (P = 0.006). The mean aspiration flow in front of the cutter was significantly faster for both beveled-tip than flat-tip cutters (P = 0.003, P = 0.023). The angle of the mean aspiration flow of both beveled-tip cutters was turned to the proximal side (P = 0.004, P = 0.003). The mean reflux flow of both beveled-tip cutters was significantly faster than that of the flat-tip cutters (P = 0.006, P = 0.006).

CONCLUSION

The beveled-tip cutters have a greater velocity of aspirating frontal and proximal flow resulting in higher aspiration rates and greater reflux flow velocity.

25 vs. 27-gauge micro-incision vitrectomy surgery for visually significant macular membranes and full-thickness macular holes: a retrospective study

BACKGROUND

To evaluate visual and safety outcomes for 25-gauge (25G) and 27-gauge (27G) micro-incision vitrectomy platforms (MIVS) for the treatment of epiretinal membrane and full-thickness macular holes.

METHODS

Retrospective analysis of all patients who underwent internal limiting membrane (ILM) peel surgery from January 2017 through December 2018. 207 cases met the eligibility criteria for inclusion. Primary endpoint was post-operative Best-Corrected Distance Visual Acuity (BCVA) at 6 months.

RESULTS

For all patients combined, mean logMAR BCVA improved from 0.57 (± 0.40) to 0.37 (± 0.36) post-operatively (p < 0.001). For 25G ERMs, logMAR BCVA improved from 0.51 (± 0.28) to 0.30 (± 0.25) post-operatively (p < 0.001). For 27G ERMs, logMAR BCVA improved from 0.33 (± 0.28) to 0.28 (± 0.27) post- operatively (p = 0.15). For 25G FTMHs, logMAR BCVA improved from 0.87 (± 0.48) to 0.51 (± 0.44) post-operatively (p < 0.001). For 27G FTMHs, logMAR BCVA changed from 0.89 (± 0.47) to 0.96 (± 0.60).

CONCLUSION

Final visual outcomes improved for both 25G and 27G ERM groups and the 25G FTMH group. Both 25G and 27G were safe and well tolerated MIVS platforms for the treatment of ERM and FTMH.

Simulation of Vitreous Traction Force and Flow Rate of High Speed Dual-Pneumatic 7500 Cuts Per Minute Vitrectomy Probes

Purpose

To develop methods to simulate vitreous flow and traction during vitrectomy and qualify these methods using laboratory measurements.

Methods

Medium viscosity and phase treatment were adjusted to represent vitreous (Eulerian two-phase flow) or saline solution (single-phase Navier-Stokes flow). Retinal traction was approximated using a one-way fluid-structure interaction simulating cut vitreous volume coupled to a structural simulation of elastic stretching of a cylinder representing vitreous fibers entrained in the flow.

Results

Simulated saline solution flow decreased, but vitreous flow increased with increasing cut rate, consistent with experimental trends observed for the 50/50 duty cycle mode. Traction simulations reproduced all trends in variation of traction force with changes in conditions. Simulations reproduced the majority of traction measurements within experimental error.

Conclusions

A scientific basis is provided for understanding how flow and traction vary with operational parameters. This model-based analysis serves as a “virtual lab” to determine optimal system settings to maximize flow efficiency while reducing traction.

Translational Relevance

The model provides a better understanding regarding how instrument settings can help control a vitrectomy procedure so that it can be made as efficient as possible (maximizing the rate of vitreous removal) while at the same time being made as safe as possible (minimizing retinal traction).

Comparison of 27-Gauge and 25-Gauge Microincision Vitrectomy Surgery for the Treatment of Vitreoretinal Disease: A Systematic Review and Meta-Analysis

BACKGROUND

We performed a systematic review and meta-analysis to evaluate the safety and effectiveness of 27-gauge (27-G) microincision vitrectomy surgery (MIVS) compared with 25-guage (25-G) MIVS for the treatment of vitreoretinal disease.

METHODS

A systematic electronic search was conducted in March 2020 in PubMed, Embase, and the Cochrane library. Eligible criteria for including studies were controlled trials comparing 27-G vitrectomy with 25-G vitrectomy in patients with vitreoretinal disease. The main outcomes included operation time; best corrected visual acuity (BCVA) in logMAR; postoperative intraocular pressure (IOP); primary anatomical success rate for rhegmatogenous retinal detachment (RRD) cases and postoperative central macular thickness (CMT) for idiopathic epiretinal membrane (ERM) cases; intraoperative/postoperative complications. Odds ratio (OR) and mean difference (MD) were synthesized under fixed or random effects models.

RESULTS

Eleven studies enrolling 940 eyes were identified. Among those 11 studies, six studies were on the treatment of RRD and five studies were on the treatment of ERM, so subgroup analyses were conducted. The total pooled results indicated that 27-G surgery system had obvious advantages in improving BCVA at six months after the vitrectomy (P = 0.004) and reducing intraoperative/postoperative complications (P = 0.03). However, the mean operation time was significantly longer by three minutes for 27-G compared with 25-G vitrectomy (P = 0.002). In subgroup analyses, for the treatment of ERM cases, 27-G group was associated with less complications and longer operation time. However, for the treatment of RRD cases, 27-G groups and 25-G groups were comparable in operation time, postoperative BCVA, postoperative IOP, and primary anatomical success rate.

CONCLUSIONS

This meta-analysis confirmed that 27-G MIVS was an effective and safe surgical system compared with 25-G MIVS for the treatment of RRD and ERM cases, even though 27-G system needs a longer surgical time.

Clinical comparison of 27-gauge and 23-gauge instruments on the outcomes of pars plana vitrectomy surgery for the treatment of vitreoretinal diseases

PURPOSE OF REVIEW

To compare outcomes of 27-gauge and 23-gauge pars plana vitrectomy (PPV) for treatment of vitreoretinal diseases.

RECENT FINDINGS

Sixty-eight patients undergoing microincisional PPV for treatment of vitreoretinal diseases were randomized 1 : 1 to 27-gauge or 23-gauge surgery with a 7500 cuts-per-minute vitrectomy probe. The most common reasons for vitrectomy were epiretinal membrane (49%) and vitreous hemorrhage (24%). Mean ± standard deviation (SD) changes from immediate preoperative to immediate postoperative intraocular pressure were -0.40 ± 6.60 mmHg in the 27-gauge and -3.05 ± 7.64 mmHg in the 23-gauge group (adjusted mean difference 2.42 mmHg, 95% lower confidence limit 0.64, P = 0.013), but these changes were not associated with primary reason for vitrectomy (P = 0.065). Mean ± SD conjunctival edema grades in the 27-gauge and 23-gauge groups 1 week after surgery were 0.02 ± 0.124 and 0.10 ± 0.246, respectively (least squares mean difference -0.09, 95% upper confidence limit -0.03, P = 0.004), and were 0.01 ± 0.122 and 0.12 ± 0.338, respectively, at the probe incision site. Conjunctival edema grades were similar in both groups at 1 and 3 months. Mean ± SD pain ratings on postoperative day 1 - an indicator of patient comfort - were similar in the two groups.

SUMMARY

Smaller diameter vitrectomy instruments are associated with smaller reductions in immediate postoperative intraocular pressure.

Hybrid 23/27 Gauge Vitrectomy - Combining the Charm of 27G with the Efficacy of 23G

Background

Minimally invasive transconjunctival sutureless vitrectomy (MIVS) has evolved into the standard of care, smaller incisions thought to result in lower ocular surface trauma and shorter times to recovery. The currently most relevant limitations in macular surgery may be light intensity and 27G instrument stability. Therefore, we thought to compare standard 23 and 27G vitrectomy with a hybrid technique using one 23G and two 27G ports regarding surgical times and short-term outcomes.

Methods

This retrospective comparison included 90 single-center consecutive cases of eyes undergoing elective micro-invasive vitrectomy for epiretinal membranes or idiopathic macular holes between October 2017 and June 2018. The main criteria for the comparison were total surgical time as primary outcome parameter and treatment-demanding intra- and postoperative complications along with recovery of best-corrected visual acuity (BCVA) and central retinal thickness (CRT) from prior to surgery to 1 month thereafter as secondary parameters as independent parameters for the recovery from the pre-existing pathology and the surgical trauma.

Results

Surgical times were shorter with 23G and 23/27G compared to 27G (23G: 38.4±13.1; 27G: 48.1±15.3; 23/27G: 34.9±9 mins; p=0.0005) with no differences in BCVA and CRT outcomes. Switching from 27G to a larger port size was not necessary in any instance. Cryotherapy was applied in 15%, 30%, and 22.5% to suspected retinal pathologies, beyond these, in 5%, 0%, and 7.5% for retinal tears. Four postoperative retinal detachments occurred (4.4%), one in the 23G and three in the 23/27G group requiring re-vitrectomy.

Conclusion

In this exploratory case series, 23/27G hybrid vitrectomy, combining the advantages of 23G and 27G techniques, resulted in shorter surgical times without evident disadvantages. The combination with cataract surgery was unproblematic.

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.

One-year outcomes of 27-gauge versus 25-gauge pars plana vitrectomy for uncomplicated rhegmatogenous retinal detachment repair

Background

27-gauge (27G) and 25-gauge (25G) transconjunctival sutureless vitrectomy (TSV) were considered equal about safety, effectiveness and vitrectomy time for the treatment of rhegmatogenous retinal detachment (RRD), although larger and long-term comparative studies are needed to confirm previous knowledge. Furthermore, a combined comparison of time duration of surgery and vitreous removal was never performed. Our purpose was to compare the safety and efficacy of 27G versus 25G TSV for the treatment of uncomplicated RRD over a 1-year follow-up.

Methods

A 12-months single-center prospective, randomized, interventional study of 92 consecutive patients was performed. 46 patients underwent 27G TSV (Group 1) and 46 underwent 25G TSV (Group 2). Primary outcomes were primary and final reattachment rate, and final functional success (visual acuity ≥ 20/200, 1 LogMar). Secondary outcomes were the surgical and vitrectomy time. Complications were recorded.

Results

All functional and morphologic data at baseline and at all follow-up time points up to 12 months after surgery were available for only 88 patients. Four patients in Group 1 dropped out of the study after surgery. There was no significant difference in baseline characteristics between the two groups. Primary and final reattachment rates were 90.5% and 100% in Group 1, and 95.6% and 100% in Group 2, respectively (p > .05, p > .05, respectively). Visual acuity improved from 1.5 ± 1.09 LogMar to 0.38 ± 0.55 LogMar in Group 1 (p < .001) and 1.2 ± 0.9 LogMar to 0.49 ± 0.53 LogMar in Group 2 (p < .001), without significant difference between the groups (p > .05). The surgical time was 73.2 ± 11.3 min with 27G TSV and 64.4 ± 9.5 min with 25G TSV (p = .0001). The vitrectomy time was 19.9 ± 3.8 min with 27G TSV and 20.8 ± 3.8 min with 25G TSV (p > .05). One single case of choroidal detachment occurred.

Conclusions

Reattachment rates, functional success and vitrectomy time were comparable between 27G and 25G TSV for RRD. Surgical time was significantly longer using 27G vitrectomy.

Results of pars plana vitrectomy for primary rhegmatogenous retinal detachment with PVR grades A and B in high-myopic eyes

PURPOSE

To evaluate the results of pars plana vitrectomy (PPV) without adjuvant buckling procedures for the primary rhegmatogenous retinal detachment (RRD) with PVR grades A and B in high-myopic eyes.

METHODS

A retrospective review included 291 eyes treated for primary RRD from 2008 to 2016. The single surgery success rate (SSSR), the total number of surgeries, outcomes and complications were analysed between group of 67 eyes with high axial myopia (group A) and group of 224 eyes without high myopia (group B).

RESULTS

The mean follow-up was 30.6 ± 22.8 months. The SSSR in group A was 82.1% and in group B was 86.2% (p > 0.05). The final reattachment rate and number of required surgeries were in group A 96.3% (3.1 surgeries) and in group B 96.0% (2.8 surgeries). The initial BCVA improved in group A from 1.58 to 0.58 LogMAR at year 3; and in group B from 1.21 to 0.34 LogMAR. In match-pair analysis of macula-off RRD, no significant difference of the CRT between groups A and B was observed within 3 years of follow-up.

CONCLUSION

The anatomical success of primary PPV for RRD did not differ between high-myopic and non-high-myopic eyes in PVR grades A and B. However, functional results of high-myopic eyes are worse compared to eyes without high axial myopia.

Clinical factors contributing to postoperative aqueous flare intensity after 27-gauge pars plana vitrectomy for the primary rhegmatogenous retinal detachment

PURPOSE

To investigate the perioperative clinical factors, which contribute to the postsurgical aqueous flare intensity (AFI) following 27-gauge pars plana vitrectomy (27GPPV) for primary rhegmatogenous retinal detachment (RRD).

STUDY DESIGN

Retrospective clinical study.

METHODS

We performed retrospective analyses of the medical records of 47 eyes of 47 patients with primary RRD who had undergone 27GPPV with a wide-angle viewing system. AFI was measured preoperatively and 1 week, 1 month, 3 months, 6 months, and 12 months after the surgery.

RESULTS

AFI was significantly increased 1 week after the surgery (p<0.01) and then decreased overtime. At 6 months after surgery it was still statistically significantly higher than preoperative AFI (p=0.03). There was no statistical difference between preoperative AFI and that at 12 months following surgery. Multiple regression analyses revealed that the number of retinal photocoagulations and the performance of scleral indentation had significant positive correlation with AFI at 1 week, 1 month, 3 months, and 6 months, and at 1 month and 3 months after the surgery, respectively.

CONCLUSION

Intraoperative retinal photocoagulation and scleral indentation are probable causes of increased AFI after 27G PPV for RRD.

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

Purpose

To compare the anatomical and visual results and complications of 27-gauge versus 25-gauge transconjunctival sutureless vitrectomy for the management of primary rhegmatogenous retinal detachment.

Methods

A prospective, propensity score-matched 6-month study was performed. All patients underwent either 27-gauge or 25-gauge vitrectomy as the first surgical intervention and were followed up over a 6-month period, in order to evaluate anatomical success, change in best-corrected visual acuity (BCVA), and intraoperative and postoperative complications including intraocular pressure dysregulation.

Results

Propensity score matching resulted in two groups of 37 eyes each. All eyes completed a six-month follow-up. Baseline demographic and preoperative ocular characteristics showed no statistically significant difference between the two cohorts. The single operation success rate was 33/37 (89%) for 27-gauge cases and 34/37 (92%) for 25-gauge cases (p=0.7). The final anatomical success rate was 100% for each of the two cohorts. Mean BCVA change at the 6-month postoperative follow-up visit was −0.67 logMAR in the 27-gauge group and −0.71 logMAR in the 25-gauge group (p=0.9). Two patients in the 25-gauge group experienced transient hypotony after surgery.

Conclusion

No significant difference between 27-gauge and 25-gauge transconjunctival sutureless vitrectomy for the repair of primary rhegmatogenous retinal detachment was recorded in terms of reattachment rate, BCVA, intraoperative and postoperative complications.

Non-Lasered Drainage Retinotomies for Repair of Primary Rhegmatogenous Retinal Detachments

BACKGROUND AND OBJECTIVE

Drainage retinotomies are a technique used for treating rhegmatogenous retinal detachments (RRDs). These retinotomies are commonly surrounded by barricade laser. This paper aims to evaluate operative success of non-lasered drainage retinotomies during 25-gauge pars plana vitrectomy (PPV) for repair of primary RRD.

PATIENTS AND METHODS

Retrospective review of a consecutive interventional case series. Study includes 45 eyes of 45 patients who underwent 25-gauge PPV with a non-lasered drainage retinotomy for primary RRD. Eyes with previous retinal detachments or less than 3 months of follow-up were excluded.

RESULTS

All PPV with non-lasered drainage retinotomies were carried out by one surgeon (RFI); 25-gauge PPV instrumentation, a wide-angle viewing system, endolaser photocoagulation, and air or sulfur hexafluoride gas tamponade were utilized for each eye. Single surgery anatomical success was achieved in 42 out of 45 eyes (93%).

CONCLUSION

Retinal detachment repair utilizing non-lasered drainage retinotomies had a high anatomic success rate comparable to that of standard retinal detachment repair.1,2 [Ophthalmic Surg Lasers Imaging Retina. 2018;49:955-960.].

Postoperative pain after vitreo-retinal surgery is influenced by surgery duration and anesthesia conduction

BACKGROUND

The control of postoperative pain (POP) is a key component of perioperative care. POP after vitreo-retinal surgery (VRS) has been under-investigated, and its incidence remains elusive.

METHODS

In order to assess POP after VRS, the associated risk factors and efficacy of the analgesic protocol in use at our institution, we made a one-year retrospective study on patients undergoing VRS. Patients aged >18 years, ASA Class I-III undergoing VRS entered the study. POP was evaluated by measuring a Numerical Rating Scale (NRS), and analgesic consumption.

RESULTS

A total of 782 patients entered the study. Patients received locoregional (LRA) or general anesthesia (GA) with supplemental block. Twenty-two percent of patients needed analgesics (acetaminophen in 97% of cases), mostly between two and six hours after surgery. The univariate analysis showed a positive association between POP and duration of surgery (P<0.0001) and glaucoma (P=0.04), and a negative association with age (P=0.008), analgesic administration at the end of surgery (P=0.005) and the intraoperative administration of remifentanil for surgery under LRA (P=0.02); sedation to execute the block for LRA did not reduce POP. Patients treated with GA with supplemental block had less pain compared to those treated with LRA with/without remifentanil (P=0.03, P=0.002, respectively). The multivariate analysis confirmed a positive correlation between POP and duration of surgery (P=0.0007) and a negative correlation with the intraoperative remifentanil administration during LRA (P=0.04), and with GA with supplemental block (P=0.01).

CONCLUSIONS

The incidence of POP after VRS is low but not absent, especially for long procedures, it does not require postoperative opioids and can be modified by anesthesiologic choices.

Surgical outcomes of 27-gauge and 25-gauge vitrectomy day surgery for proliferative diabetic retinopathy

PURPOSE

To compare postoperative outcomes of 27-gauge (G) and 25-G vitrectomy conducted as day surgery for proliferative diabetic retinopathy (PDR).

METHODS

One hundred eighty-five consecutive PDR patients (185 eyes) who underwent primary vitrectomy (27-G in 64 eyes, 25-G in 121 eyes) were analyzed.

RESULTS

The 27-G and 25-G groups did not differ significantly in preoperative Early Treatment Diabetic Retinopathy Study (ETDRS) score, age, or preoperative intraocular pressure. The proportions of simultaneous cataract surgery (27-G vs. 25-G: 59.4% vs. 62.4%) and air-filled eyes (76.6% vs. 85.1%) were not significantly different between two groups. Both groups showed significant improvement in ETDRS score at postoperative 1, 3, and 6 months (all, P < 0.0001). Mean gain in ETDRS score from baseline was apparently better in 27-G group than in 25-G group at 1, 3, and 6 months, but there were no significant differences (1 month: 20.3 vs. 13.1 letters, P = 0.0703; 3 months: 22.9 vs. 17.5 letters, P = 0.1561; 6 months: 24.3 vs. 19.3 letters, P = 0.3313). Operation time was apparently longer for 27-G vitrectomy, but there was no significant difference (54.0 vs. 51.1 min, P = 0.3676). The same was observed for postoperative intraocular pressure at postoperative day 1 (19.7 vs. 18.1 mmHg, P = 0.1353). Incidence of postoperative retinal detachment (1.6% vs. 0.8%) and reoperation due to vitreous hemorrhage (6.3% vs. 6.6%) was not different between two groups.

CONCLUSIONS

The 27G system is as safe and as useful as the 25G system when used for PDR and can be expected to achieve earlier recovery of postoperative visual acuity.

Retrospective Comparison of 27-Gauge and 25-Gauge Microincision Vitrectomy Surgery with Silicone Oil for the Treatment of Primary Rhegmatogenous Retinal Detachment

Aim

To retrospectively compare the safety and effectiveness of 27-gauge (27G) microincision vitrectomy surgery (MIVS) with 25-guage (25G) MIVS for the treatment of primary rhegmatogenous retinal detachment (RRD) with silicone oil tamponade.

Methods

Ninety-two patients with RRD who underwent MIVS from May 1, 2015, to June 30, 2017, were included in this study. Fifty-eight eyes underwent 25G MIVS and 34 eyes underwent 27G MIVS. We analyzed the characteristics of the patients, surgical time, main clinical outcomes, and rate of complications.

Results

The mean surgical time was 56.7 ± 35.9 min for the 25G MIVS and 55.7 ± 36.1 min for the 27G MIVS, and there was no significant difference (P=0.894) between the two groups. The primary anatomical success rate after a single operation was 94.8% for 25G MIVS and 91.2% for 27G MIVS (P=0.666). Baseline and final visit best-corrected visual acuity (BCVA) were 1.9 ± 1.1 and 1.0 ± 0.8 in the 25G group, and 1.7 ± 1.0 and 1.1 ± 0.8 in the 27G group. Last visit BCVA increased significantly in both groups (P < 0.001). However, there were no significant differences in terms of visual improvement ratio (>0.2 logMAR) between the two groups (P=0.173). No severe intraoperative complication was observed. Iatrogenic retinal breaks occurred in 2 eyes (3.4%) in the 25G group and 1 eye (2.9%) in the 27G group during the peripheral vitreous base shaving. The transient ocular hypertension (>25 mmHg) within postoperative week 1 was 25.9% in the 25G group and 11.8% in the 27G group (P=0.120).

Conclusions

This study found no significant anatomical or functional difference between 27G and 25G MIVS in the treatment of primary RRD. Therefore, 27G vitrectomy appears to be a safe and effective surgery for the treatment of primary RRD.

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.].

Comparison of 25- and 27-Gauge Pars Plana Vitrectomy in Repairing Primary Rhegmatogenous Retinal Detachment

Aim

To compare the anatomic and visual outcomes of 25-gauge (25G), and 27-gauge (27G) transconjunctival sutureless pars plana vitrectomy (TSV) for the management of primary rhegmatogeneous retinal detachment (RRD).

Design

A retrospective nonrandomized clinical trial.

Methods

A retrospective comparative analysis of 62 consecutive eyes from 62 patients with 6 months of follow-up was performed.

Results

Thirty-two patients underwent 25G TSV, and 30 patients underwent 27G TSV for the treatment of primary RRD. There was no significant difference in baseline demographic and preoperative ocular characteristics between the two groups. The initial and final anatomical success rates were 93.8% and 100% in 25G TSV and 96.7% and 100% in 27G TSV, respectively (p=1 and p=1, resp.). Preoperative best-corrected visual acuity (BCVA) (logMAR) was 0.44 ± 0.69 and 0.38 ± 0.61 for 25G and 27G TSV, respectively (p=0.73). The final follow-up BCVA was 0.07 ± 0.25 and -0.02 ± 0.17 for 25G and 27G TSV, respectively (p=0.16). The final BCVA was significantly better than the preoperative BCVA in both groups (p=0.02 and p=0.002, resp.). Preoperative intraocular pressure (IOP) (mmHg) was 13.0 ± 3.5 in 25G TSV and 14.3 ± 2.8 in 27G TSV (p=0.11). IOP did not statistically significantly change in both groups during the follow-up period (p=0.63 and p=0.21, resp.).

Conclusion

The 27G TSV system is safe and useful for RRD treatment as 25G TSV.

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.