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Sborgia G, Niro A, Sborgia L, Grassi MO, Gigliola S, Romano MR, Boscia F, Sborgia A, Alessio G. One-year outcomes of 27-gauge versus 25-gauge pars plana vitrectomy for uncomplicated rhegmatogenous retinal detachment repair. Int J Retina Vitreous 2019; 5:13. [PMID: 31171987 PMCID: PMC6547499 DOI: 10.1186/s40942-019-0164-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2019] [Accepted: 04/20/2019] [Indexed: 11/26/2022] Open
Abstract
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.
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Affiliation(s)
- Giancarlo Sborgia
- 1Department of Medical Science, Neuroscience and Sense Organs, Eye Clinic, University of Bari, Bari, Italy
| | - Alfredo Niro
- Eye Clinic, Hospital "S. G. MOSCATI", ASL TA, Via per Martina Franca, 74010 Statte, Taranto, Italy
| | - Luigi Sborgia
- 1Department of Medical Science, Neuroscience and Sense Organs, Eye Clinic, University of Bari, Bari, Italy
| | - Maria Oliva Grassi
- 1Department of Medical Science, Neuroscience and Sense Organs, Eye Clinic, University of Bari, Bari, Italy
| | - Samuele Gigliola
- 1Department of Medical Science, Neuroscience and Sense Organs, Eye Clinic, University of Bari, Bari, Italy
| | - Mario R Romano
- 3Department of Ophthalmology, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Francesco Boscia
- 4Department of Surgical, Microsurgical and Medical Sciences, Eye Clinic, University of Sassari, Sassari, Italy
| | - Alessandra Sborgia
- 1Department of Medical Science, Neuroscience and Sense Organs, Eye Clinic, University of Bari, Bari, Italy.,Eye Clinic, Hospital "S. G. MOSCATI", ASL TA, Via per Martina Franca, 74010 Statte, Taranto, Italy
| | - Giovanni Alessio
- 1Department of Medical Science, Neuroscience and Sense Organs, Eye Clinic, University of Bari, Bari, Italy
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Hsu CM, Chen SC, Wu TT, Sheu SJ. Outcomes of 23-gauge transconjunctival sutureless vitrectomy for acute postoperative endophthalmitis. J Chin Med Assoc 2017; 80:503-507. [PMID: 28601626 DOI: 10.1016/j.jcma.2017.05.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2015] [Revised: 05/11/2017] [Accepted: 03/03/2016] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND To report our 3-year experience of 23-gauge transconjunctival sutureless vitrectomy (TSV) for acute postoperative endophthalmitis at a tertiary referral center in southern Taiwan. METHODS This retrospective chart review study included 19 patients with acute postoperative endophthalmitis who underwent 23-gauge TSV from January 2011 to January 2015 at Kaohsiung Veterans General Hospital, Taiwan. Bacterial and fungal cultures from aqueous samples, vitreous samples, or both were performed. RESULTS Nineteen patients (12 male; 7 female) were included. The mean age was 72.4 ± 8.29 years. Acute postoperative endophthalmitis was noted in 18 patients after cataract surgery and in 1 patient after 23-gauge vitrectomy for a rhegmatogenous retinal detachment. Upon presentation, visual acuity was less than hand movement for 80% of the patients. Chief complaints included blurred vision (19 patients, 100%), followed by pain (10 patients, 52.6%) and red eye (4 patients, 21%). All patients were administered an intravitreal injection (IVI) of antibiotics and 23-gauge TSV, and the average number of IVIs was 2.68 ± 1.73 (1-9 IVIs). The interval between their initial eye symptoms and vitrectomy was 4.11 ± 4.73 days (0-2 days), and the interval between diagnosis with endophthalmitis and a vitrectomy was 1.11 ± 1.52 days (0-6 days). The final visual acuity was no light perception for 1 patient (5.3%), between 6/60 and 6/12 for 8 patients (42.1%), and 6/12 or better for 9 patients (47.4%). No retinal detachment or hypotony was noted postoperatively in any case. CONCLUSION 23-gauge vitrectomy is safe and effective for the management of acute postoperative endophthalmitis. Early diagnosis and treatment with 23-gauge vitrectomy may provide a good visual outcome.
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Affiliation(s)
- Chia-Ming Hsu
- Department of Ophthalmology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC
| | - Shih-Chou Chen
- Department of Ophthalmology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC
| | - Tsung-Tien Wu
- Department of Ophthalmology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC; National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC.
| | - Shwu-Jiuan Sheu
- Department of Ophthalmology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC; National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC
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Kim YK, Kim YW, Woo SJ, Park KH. Comparison of surgically-induced astigmatism after combined phacoemulsification and 23-gauge vitrectomy: 2.2-mm vs. 2.75-mm cataract surgery. Korean J Ophthalmol 2014; 28:130-7. [PMID: 24688255 PMCID: PMC3958628 DOI: 10.3341/kjo.2014.28.2.130] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2013] [Accepted: 05/28/2013] [Indexed: 12/01/2022] Open
Abstract
Purpose The 2.2-mm microincision cataract surgery and small-gauge vitrectomy system is known to result in less surgically-induced astigmatism (SIA) in comparison to conventional surgical methods. We compared the amounts of SIA after combined phacoemulsification and 23-gauge transconjunctival sutureless vitrectomy (23G-TSV) using the 2.2-mm microincision and 2.75-mm standard incision methods. Methods We studied 59 patients (61 eyes) who underwent combined phacoemulsification and 23G-TSV from November 2008 to September 2012. Twenty-eight patients (28 eyes) underwent 2.2-mm microincision coaxial phacoemulsification, and 31 patients (33 eyes) underwent 2.75-mm standard incision phacoemulsification. SIA was evaluated using Naeser's polar method with the simulated keratometric values obtained from corneal topography. Preoperative and 1-week and 1-month postoperative KP (Naeser's polar value along the specific axis) and ΔKP values were compared between the 2.2-mm microincision and 2.75-mm standard incision groups. Results One week after surgery, both groups exhibited similar amounts of SIA (-ΔKP[120], 0.40 ± 0.41 vs. 0.51 ± 0.56 diopters [D]; p = 0.390). One month after surgery, however, the amount of SIA was significantly smaller in the 2.2-mm microincision group as compared to the 2.75-mm standard incision group (-ΔKP[120], 0.31 ± 0.54 vs. 0.56 ± 0.42 D; p = 0.045). Conclusions In combined phacoemulsification with 23G-TSV, 2.2-mm microincision coaxial phacoemulsification induces less SIA than does 2.75-mm standard coaxial phacoemulsification.
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Affiliation(s)
- Yong-Kyu Kim
- Department of Ophthalmology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Yong Woo Kim
- Department of Ophthalmology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Se Joon Woo
- Department of Ophthalmology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Kyu Hyung Park
- Department of Ophthalmology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
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Gosse E, Newsom R, Hall P, Lochhead J. Changes in day 1 post-operative intraocular pressure following sutureless 23-gauge and conventional 20-gauge pars plana vitrectomy. Open Ophthalmol J 2013; 7:42-7. [PMID: 24015163 PMCID: PMC3763675 DOI: 10.2174/1874364101307010042] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2013] [Revised: 07/13/2013] [Accepted: 07/17/2013] [Indexed: 01/07/2023] Open
Abstract
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.
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Affiliation(s)
- Emily Gosse
- Department of Ophthalmology, St Mary's Hospital, Newport, Isle of Wight, UK
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