Pars Plana Vitrectomy Port Sizes: A Meta-Analysis of Randomized Controlled Trials

Autologous-Fibrin Induction: A Novel Approach for Sutureless Sclerotomy Closure in Pars Plana Vitrectomy

PURPOSE

This study presents a novel sutureless closure approach for sclerotomies following pars plana vitrectomy (PPV) and assesses its efficacy and safety.

METHODS

A total of 142 eyes were included in the study. PPV procedures were performed using 23-gauge (23 G) or 25-gauge (25 G) systems. Preoperative characteristics, intraoperative findings, and postoperative outcomes were documented.

RESULTS

The cohort included 80 males and 62 females (mean age: 60.4 ± 12 years), primarily undergoing surgery for retinal detachment (59%). Among the patients, 87% underwent 25 G PPV (35% three-port, 52% four-port), while 13% underwent 23 G PPV (12% three-port, 1% four-port). Gas tamponade was administered in all cases, with perfluoropropane used in 45.7% of instances, sulfur hexafluoride in 29.5%, and air in 24.6%. Spontaneous closure was observed in 9.4% (47 of 501) of sclerotomies, autologous-fibrin induction approach successfully closed 75.8% (380 of 501) of the sclerotomies (83.7% of leaking sclerotomies) and 14.7% (74 of 501) of sclerotomies needed sutures. Visual acuity improved postoperatively, and first-day hypotony rate was 6.3%. Importantly, no serious complications such as choroidal detachment or endophthalmitis were observed during the postoperative period.

CONCLUSION

The autologous-fibrin induction offers a simple, cost-efficient, and reliable approach for sutureless sclerotomy closure in PPV, with promising outcomes.

Outcomes of 23-Gauge Pars Plana Vitrectomy in Various Vitreoretinal Diseases

Background This study aimed to evaluate the safety, efficacy, and complications of 23-gauge (23-G) pars plana vitrectomy (PPV) in the treatment of various vitreoretinal diseases. Methodology A retrospective, cross-sectional study was conducted at Al-Shifa Trust Eye Hospital, Rawalpindi. All the eyes undergoing 23-G PPV between June 2020 and May 2023 meeting the inclusion criteria were included. Surgical outcomes and complications were assessed. Results A total of 350 eyes were included in our data. The most common indication was rhegmatogenous retinal detachment (RRD) (n = 144, 41.1%), followed by diabetic tractional retinal detachment (TRD) (n = 98, 21%). Satisfactory anatomical outcomes were achieved in all the indications. The primary success rate was 87.5% for RRD and 96.9% for TRD. The overall complication rate was 17.7%, with postoperative cataracts being the most frequent. Conclusions The 23-G PPV technique has proven to be a safe and effective approach for the surgical management of various vitreoretinal diseases, demonstrating favorable anatomical outcomes and a low rate of complications.

Twenty-seven-gauge vitrectomy: a consecutive, single-centre case series with exclusive use over a 4-year period

BACKGROUND

To assess the safety and effectiveness of the exclusive use of 27-gauge instruments for all vitreoretinal diseases requiring vitrectomy.

METHODS

In this retrospective study, 1020 consecutive surgeries were performed on 958 eyes of 848 patients using 27-gauge instruments from March 2017 to June 2021. Patients with a minimum follow-up of 3 months were included. Surgical case-mix, best-corrected visual acuity (BCVA), intraocular pressure (IOP), intra- and post-operative complications, and surgery times were recorded.

RESULTS

The study patients were followed up for averagely 11 months. Of the 1020 vitrectomies, 958 were primary procedures. Of the 148 retinal detachment (RD) cases, 138 (93%) required a single vitrectomy. Primary macular hole closure was achieved in 143 of 145 (99%) cases. The average surgical times were 55 and 38 min for RD surgeries and for all other indications, respectively. BCVA improved significantly at the final visit (20/49) compared with the pre-operative visit (20/78) (p < 0.01). IOP was similar at the pre-operative (14.8mmHg) and final (14.3mmHg) visits. Complications recorded include transient hypotony in 39 eyes, iatrogenic retinal breaks in 2 eyes, and a vitreous bleed in 1 other eye.

CONCLUSION

This study revealed that 27-gauge vitrectomy instruments can be used for a wide range of indications, with exclusive use in certain settings. The outcomes were similar to other gauges, including for rhegmatogenous retinal detachment, with minimal complications.

Comparison of 27-gauge beveled-tip and 25-gauge flat-tip microincision vitrectomy surgery in the treatment of proliferative diabetic retinopathy: a randomized controlled trial

PURPOSE

To compare the effectiveness and safety of a 27-gauge (27G) beveled-tip microincision vitrectomy surgery (MIVS) with a 25-gauge (25G) flat-tip MIVS for the treatment of proliferative diabetic retinopathy (PDR).

METHODS

A prospective, single-masked, randomized, controlled clinical trial included 52 eyes (52 patients) with PDR requiring proliferative membrane removal. They were randomly assigned in a 1:1 ratio to undergo the 27G beveled-tip and or 25G flat-tip MIVS (the 27G group and the 25G group, respectively). During surgery, the productivity of cutting the membrane, the number of vitrectomy probe (VP) exchanges to microforceps, total operation time, vitrectomy time and intraoperative complications were measured. Best-corrected visual acuity (BCVA), intraocular pressure (IOP) and postoperative complications were also assessed to month 6.

RESULTS

Forty-seven eyes (47 patients) completed the follow-up, including 25 in the 27G group and 22 in the 25G group. During surgery in the 27G group, cutting the membrane was more efficient (P = 0.001), and the number of VP exchanges to microforceps was lower (P = 0.026). The occurrences of intraoperative hemorrhages and electrocoagulation also decreased significantly (P = 0.004 and P = 0.022). There were no statistical differences in the total operation time or vitrectomy time between the two groups (P = 0.275 and P = 0.372), but the former was slightly lower in the 27G group. Additionally, the 27G group required fewer wound sutures (P = 0.044). All the follow-up results revealed no significant difference between the two groups.

CONCLUSIONS

Compared with the 25G flat-tip MIVS, the 27G beveled-tip MIVS could be more efficient in removing the proliferative membrane while reducing the occurrence of intraoperative hemorrhages and electrocoagulation using appropriate surgical techniques and instrument parameters. Its vitreous removal performance was not inferior to that of the 25G MIVS and might offer potential advantages in total operation time. In terms of patient outcomes, advanced MIVS demonstrates equal effectiveness and safety to 25G flat-tip MIVS.

TRIAL REGISTRATION

The clinical trial has been registered at Clinicaltrials.gov (NCT0544694) on 07/07/2022. And all patients in the article were enrolled after registration.