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

In vivo evaluation of a Nano-enabled therapeutic vitreous substitute for the precise delivery of triamcinolone to the posterior segment of the eye

This study focused on the design of a thermoresponsive, nano-enabled vitreous substitute for the treatment of retinal diseases. Synthesis of a hydrogel composed of hyaluronic acid and a poloxamer blend was undertaken. Poly(D,L-lactide-co-glycolide) acid nanoparticles encapsulating triamcinolone acetonide (TA) were synthesised with a spherical morphology and mean diameter of ~ 153 nm. Hydrogel fabrication and nanoparticle loading within the hydrogel was confirmed via physicochemical analysis. Gelation studies indicated that hydrogels formed in nine minutes and 10 min for the unloaded and nanoparticle-loaded hydrogels, respectively. The hydrogels displayed in situ gel formation properties, and rheometric viscoelastic studies indicated the unloaded and loaded hydrogels to have modulus values similar to those of the natural vitreous at 37 °C. Administration of the hydrogels was possible via 26G needles allowing for clinical application and drug release of triamcinolone acetonide from the nanoparticle-loaded hydrogel, which provided sustained in vitro drug release over nine weeks. The hydrogels displayed minimal swelling, reaching equilibrium swelling within 12 h for the unloaded hydrogel, and eight hours for the nanoparticle-loaded hydrogel. Biodegradation in simulated vitreous humour with lysozyme showed < 20% degradation within nine weeks. Biocompatibility of both unloaded and loaded hydrogels was shown with mouse fibroblast and human retinal pigment epithelium cell lines. Lastly, a pilot in vivo study in a New Zealand White rabbit model displayed minimal toxicity with precise, localised drug release behaviour, and ocular TA levels maintained within the therapeutic window for the 28-day investigation period, which supports the potential applicability of the unloaded and nanoparticle-loaded hydrogels as vitreous substitutes that function as drug delivery systems following vitrectomy surgery.

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

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

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.

Safety and efficacy of 27-gauge transconjunctival vitrectomy for the diagnosis of posterior uveitis or pan uveitis of unknown origin

Background

Diagnostic vitrectomy is an important method for evaluating uveitis, and its diagnostic utility is high regardless of whether the uveitis is infectious or non-infectious. The course of diagnostic vitreous surgery with 27-gauge pars plana vitrectomy and perioperative complications is reported.

Methods

An observational retrospective study of patients who underwent 27-gauge diagnostic vitrectomy due to atypical intraocular inflammation was conducted. The final diagnosis rate, complications due to surgery, preoperative visual acuity, and postoperative visual acuity (1 month and 6 months after surgery) were examined retrospectively.

Results

Diagnostic vitreous surgery was performed in 32 patients and 35 eyes (14 males and 18 females, age 14–85 years, median 67 years) during the study period. The average operation time was 52 min for 19 eyes with cataract surgery and 35 min for 16 eyes without cataract surgery. Preoperative log(minimum angle of resolution [MAR]) visual acuity was 0.84 ± 0.87, 1-month postoperative logMAR visual acuity was 0.41 ± 0.55 (p = 0.004, n = 28), and 6-month postoperative average logMAR visual acuity was 0.45 ± 0.73 (p = 0.012, n = 15). The diagnosis was made by diagnostic vitrectomy in 19 cases (54%). Postoperative complications were observed in 2 of 35 postoperative patients (5%); one involved increased intraocular pressure, and the other case involved vitreous hemorrhage of the eye, necessitating reoperation.

Conclusion

Diagnostic 27-gauge vitrectomy could be effective for evaluating intraocular inflammation.

Outcomes of Primary 27-Gauge Vitrectomy for 73 Consecutive Cases With Uveitis-Associated Vitreoretinal Disorders

Background: Since the advent of 27-gauge microincision vitrectomy system a decade ago, evidence regarding the feasibility, safety, and effectiveness of 27-gauge pars plana vitrectomy (PPV) has increased. Aim: To assess the effectiveness and safety profile of 27-gauge PPV for various vitreoretinal conditions associated with uveitis. Methods: We retrospectively investigated 73 consecutive cases that underwent primary 27-gauge PPV for uveitis-related ocular disorders between October 2014 and April 2021. The primary outcome measures were mean change in logMAR best-corrected decimal visual acuity (BCVA) pre-operatively to 3 months post-operatively, the proportion of BCVA improvement category defined as the degree of logMAR BCVA difference ("improved" [≤-0.3], "unchanged" [-0.3 to 0.3], and "worsened" [≥0.3]) pre-operatively to 3 months post-operatively, the mean change in intraocular inflammation scores pre-operatively to 3 months post-operatively; and intraoperative and post-operative complications. Results: The mean logMAR BCVA significantly improved from 0.69 pre-operatively to 0.42 at 3 months post-operatively (P = 0.017). The percentages of eyes with "improved," "unchanged," and "worsened" BCVA at 3 months post-operatively were 37, 50, and 13%, respectively. The mean anterior chamber cell score was 0.6 pre-operatively and 0.2 at 3 months post-operatively (P = 0.001), the mean anterior chamber flare score was 0.4 pre-operatively and 0.1 at 3 months post-operatively (P = 0.004), and the mean vitreous haze score was 1.9 pre-operatively and 0.1 at 3 months post-operatively (P < 0.001). Surgery-related complications occurred in 35 (48%) eyes, 68% of which were related to intraocular pressure and transient. Conclusions: Given its risk-benefit profile, 27-gauge PPV is a promising option for the treatment of vitreoretinal disorders in uveitis.

The contribution of the proximity of the retinal detachment to the fovea for postoperative metamorphopsia after 27-gauge pars plana vitrectomy for the primary rhegmatogenous retinal detachment

Purpose

To investigate clinical factors contributing to metamorphopsia after 27-gauge pars plana vitrectomy (27GPPV) for primary rhegmatogenous retinal detachment (RRD) to reveal whether the proximity of the preoperative retinal detachment to the fovea is associated with postoperative metamorphopsia.

Methods

We retrospectively reviewed medical records of 77 eyes of 77 patients after 27GPPV for RRD. Patients were subdivided into three groups using optical coherence tomography findings: Group A, patients with RRD outside the vascular arcade; Group B, patients whose condition was present within the vascular arcade, but without foveal detachment; and Group C, patients with foveal detachment.

Results

The average metamorphopsia score (°) assessed with M-charts 12 months after surgery was 0.01 ± 0.04 in Group A (24 eyes), 0.08 ± 0.18 in Group B (20 eyes), and 0.49 ± 0.48 in Group C (33 eyes) (p<0.001). Logistic regression analysis revealed that metamorphopsia at 12 months after surgery significantly correlated with the proximity of the retinal detachment to the fovea (p = 0.007).

Conclusion

Metamorphopsia after 27GPPV for RRD correlated with the proximity of the preoperative retinal detachment to the fovea. Attention should be paid to the possibility of postoperative metamorphopsia development when retinal detachment is present within a vascular arcade even if the fovea is not involved.

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.

Micro-incision vitrectomy surgery for primary rhegmatogenous retinal detachments with posterior vitreous detachments in elderly patients: Preoperative characteristics and surgical outcomes

Purpose

To assess the preoperative characteristics and surgical outcomes of using micro-incision vitrectomy surgery (MIVS) to treat RRD with posterior vitreous detachment (PVD) in an older and a younger patient group.

Methods

This retrospective cohort study included 407 eyes from 397 patients with primary RRD with PVD who were consecutively treated in our hospital from February 2016 to February 2020. PVD was diagnosed clinically by the presence of a Weiss ring, or was diagnosed morphologically via optical coherence tomography and subsequently confirmed during surgery. The main outcome measures were preoperative RRD characteristics, best-corrected visual acuity (BCVA), and postoperative complications.

Results

Data were analysed from 55 eyes in the elderly group (age 70 and older), and 352 eyes in the young group (age 69 and younger). There was no significant inter-group difference in the initial reattachment rate. Preoperative characteristics indicated that elderly patients had a significantly lower rate of phakic eyes, shorter mean axial length, lower lattice incidence, and longer time spans from onset to surgery. There were no significant between-group differences in the incidence of the following complications: fibrin formation, intraocular pressure elevation, epi-retinal membrane on the macula, intraocular lens optic capture, proliferative vitreoretinopathy, and vitreous haemorrhage. While the elderly patients had significant postoperative improvements in BCVA, these improvements were significantly lower than those of the younger patients.

Conclusions

This study highlighted the characteristics and surgical outcomes of MIVS in elderly patients with RRD. Although the time from onset to surgery was longer, MIVS still can be performed safely to improve older patients’ postoperative BCVA.

Impact of different manufacturers and gauge sizes on the performance of backflush needle

The present study aimed to identify the factors regulating aspiration rate (AR) of backflush needles and to compare those factors across various backflush needles from different manufacturers. The 27-gauge (27G), 25-gauge, and 23-gauge backflush needles from four different manufacturers, Alcon, MedOne, VitreQ, and DORC, were used for this experiment. AR was measured at four different aspiration vacuum levels: 100, 200, 400, and 650 mmHg. AR was significantly increased as the aspiration vacuum level increased when both aspirating balanced salt solution (BSS) and ethylene glycol; however, 27G products from VitreQ and MedOne were unable to aspirate ethylene glycol at the low aspiration vacuum level of 100 mmHg. When aspirating BSS at the high aspiration vacuum level of 650 mmHg, a smaller gauge number generally resulted in a significantly higher AR. AR, inner diameter, and cross-sectional area in Alcon products were significantly larger in any gauge, and the shaft length of Alcon products was significantly shorter than those of other manufacturers’ products in any gauge. Cross-sectional area negatively correlated with the degree of shaft deflection (r² = 0.21, p = 0.042). These results imply that AR differs significantly among backflush needles and among companies depending on the shaft cross-sectional area.

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.

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.

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.

Inner Retinal Layer and Outer Retinal Layer Findings after Macular Hole Surgery Assessed by means of Optical Coherence Tomography

AIM

To summarize the spectrum of optical coherence tomography (OCT) and OCT angiography (OCTA) features after full-thickness macular hole (MH) repair surgery.

METHODS

A PubMed engine search was carried out using the terms "Macular Hole," "Optical Coherence Tomography," and "Optical Coherence Tomography Angiography." All reports published in English up to October 2018, irrespective of their publication status, were included. Tomographic signs analyzed were divided according to the involved portion of the retina in "inner retinal layers" and "external retinal layers." Despite predominantly involving the inner retinal layers, cystoid macular edema (CME) has been treated as a separate entity. Finally, report on vessel density (VD) changes and the foveal avascular zone (FAZ) area modifications have been included.

RESULTS

Different clinical findings can be observed on OCT of patients who underwent MH repair surgery. There is general consent that retinal thinning involving primarily the retinal nerve fiber layer and the ganglion cell layer takes place after surgery. In the postoperative period, the outermost retinal layers get progressively restored. Persistent defects in the ellipsoid zone or in the external limiting membrane correlate with worse postoperative visual outcome. OCTA has globally demonstrated that eyes after MH closure show a reduction in macular and paramacular VD and smaller FAZ areas, compared with control or fellow eyes.

CONCLUSION

Clinicians should be aware of the most common tomographic findings to properly manage each condition. In addition, significant advantages for the postoperative application of OCT and OCTA include noninvasiveness, rapid and simple execution, repeatability, and precise measurements.

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.

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.

Scleral buckling in the management of rhegmatogenous retinal detachment: patient selection and perspectives

Although the technique of pars plana vitrectomy (PPV) develops rapidly, scleral buckling (SB) has several advantages over PPV for rhegmatogenous retinal detachment (RRD), including early visual rehabilitation and prevention of cataract progression. It is recommended to select the primary procedure for RRD by considering the advantages and disadvantages of each procedure based on the patient status. The vitreous body status affects the features of RRD. Vitreous liquefaction is an age-dependent process, resulting in the development of posterior vitreous detachment (PVD). RRD is usually associated with PVD, typically presenting with a retinal tear, strong vitreoretinal traction, and bullous detachment. In contrast, RRD may develop without PVD, and typically presents with a small atrophic hole, shallow detachment, and slow progression. RRD with less liquefied vitreous and no PVD can be managed successfully with SB alone even in the presence of subretinal strand as less liquefied vitreous acts as bio-tamponade blocking fluid passage. The strong traction induced by PVD and bullous detachment in an eye with extensively liquefied vitreous reduces the success rate of SB. PPV is gaining popularity as the primary procedure for RRD, especially in eyes with retinal tears, PVD, or pseudophakia. Nevertheless, SB remains the preferred procedure in young phakic patients without PVD.