The safety and efficacy of transconjunctival sutureless 23-gauge vitrectomy

PURPOSE: To evaluate the efficacy and safety of vitreoretinal surgery using a 23-gauge transconjunctival sutureless vitrectomy (TSV) system for various vitreoretinal diseases. METHODS: A retrospective, consecutive, interventional case series was performed for 40 eyes of 40 patients. The patients underwent vitreoretinal procedures using the 23-gauge TSV system, including idiopathic epiretinal membrane (n=7), vitreous hemorrhage (n=11), diabetic macular edema (n=10), macular hole (n=5), vitreomacular traction syndrome (n=5), diabetic tractional retinal detachment (n=1), and rhegmatogenous retinal detachment (n=1). Best corrected visual acuity (BCVA), intraocular pressure (IOP), and intra- and post-operative complications were evaluated. RESULTS: Intraoperative suture placement was necessary in 3 eyes (7.5%). The median BCVA improved from 20/400 (LogMAR, 1.21+/-0.63) to 20/140 (LogMAR, 0.83+/-0.48) at 1 week (p=0.003), 20/100 (LogMAR, 0.85+/-0.65) at 1 month (p=0.002), 20/100 (LogMAR, 0.73+/-0.6) at 3 months (p=0.001). In 1 eye, IOP was 5 mmHg at 2 hours and 4 mmHg at 5 hours, but none of the eyes showed hypotony after 1 postoperative day. No serous postoperative complications were observed during a mean follow-up of 8.4+/-3.4 months (range 3-13 months) CONCLUSIONS: The 23-gauge TSV system shows promise as an effective and safe technique for a variety of vitreoretinal procedures. It appears to be a less traumatic, more convenient alternative to 20-gauge vitrectomy in some indications.     

Postoperative complications associated with 25-gauge pars plana vitrectomy.

BACKGROUND AND OBJECTIVE: To report postoperative complications in eyes undergoing 25-gauge pars plana vitrectomy (PPV). PATIENTS AND METHODS: Seventy consecutive eyes that underwent 25-gauge PPV for various indications, including epiretinal membrane, non-clearing vitreous hemorrhage, and idiopathic macular hole, and had a minimum follow-up of 12 weeks were reviewed retrospectively. Main outcome measures included best-corrected Snellen visual acuity, intraocular pressure (IOP), intraoperative complications, and postoperative complications. RESULTS: The mean visual acuity improved from 20/368 preoperatively to 20/105 postoperatively (P < .00005). Intraoperative complications included retinal tears in 2 eyes (2.9%). Postoperative complications included cataract progression in 17 eyes (42.5%), cystoid macular edema exacerbation in 5 eyes (7.1%), and retinal detachment in 1 eye (1.4%). Postoperative day 1 IOP was statistically lower than preoperative IOP in fluid-filled eyes (P = .031) but not in eyes filled with intravitreal air (P = .30) or gas (P = .52). Sclerotomy sutures were required intraoperatively in 5 eyes (7.1%) and postoperative day 1 hypotony was noted in 4 eyes (5.7%). All of these complications were noted in fluid-filled eyes except for one case of postoperative day 1 hypotony with gas tamponade. CONCLUSIONS: Intraoperative and postoperative complications were rare in this series of 25-gauge PPV. Postoperative cataract progression and hypotony were the most common complications. Fluid-filled eyes appear to have a higher risk of wound leakage and postoperative hypotony after 25-gauge PPV than eyes with air or gas tamponade.     

Early postoperative hypotony after 25-gauge sutureless vitrectomy with straight incisions

PURPOSE: To evaluate the rate, duration, and associated complications of postoperative hypotony after 25-gauge sutureless vitrectomy. METHODS: In a retrospective, interventional, institutional case series, 25-gauge sutureless vitrectomy with straight incisions was performed on 111 eyes. Postoperative intraocular pressure (IOP) was measured routinely at 2 hours, 1 day, 1 week, and 1 month. Postoperative IOP, hypotony (IOP, <8 mmHg) rates, and complications associated with low IOP were assessed to determine outcome. RESULTS: Mean follow-up +/- SD was 5.45 +/- 3.44 months. Mean IOP decreased significantly by 2 hours and on postoperative day 1 (P < 0.001) and increased to preoperative levels at week 1 (P = 0.48). Postoperative hypotony rates were 26.12%, 17.11%, and 8.10% at 2 hours, 1 day, and 1 week, respectively. The ratio of postoperative vitreous hemorrhage in eyes with and without hypotony on day 1 was 2:6 (P = 0.412). Two eyes with macular holes (MHs) filled inadequately with gas endotamponade that remained hypotonic for the first postoperative week underwent reoperation due to unsealed MHs. CONCLUSIONS: Twenty-five-gauge sutureless vitrectomy with straight incisions resulted in a hypotony rate of 26.12% at 2 hours that decreased to 17.11% on day 1 and to 8.10% at week 1 but did not increase the incidence of postoperative complications.     

Incidence of complications in 25-gauge transconjunctival sutureless vitrectomy based on the surgical indications.

BACKGROUND AND OBJECTIVE: The complications of 25-gauge transconjunctival sutureless vitrectomy based on the surgical indications were reviewed. PATIENTS AND METHODS: Thirty-eight patients underwent 25-gauge transconjunctival sutureless vitrectomy. Indications for vitrectomy, preoperative and postoperative best-corrected visual acuity, preoperative and postoperative intraocular pressure, and any intraoperative or postoperative complications were recorded. RESULTS: Complications included the need to suture a leaking sclerotomy intraoperatively in four eyes (9%), all of which involved oil removal; postoperative hypotony with choroidals in two eyes (5%); mild progression of nuclear sclerotic cataract in one eye (2% of all eyes, 4% of phakic eyes); the need to switch to 20-gauge pars plana vitrectomy in one eye (2%); corneal abrasion in one eye (2%); and retinal detachment in one eye (2%). Sclerotomy leakage and hyopotony with choroidals were only encountered in cases involving previously vitrectomized eyes, whereas none of the eyes without previous vitrectomy had leakage-related complications. CONCLUSIONS: Previously vitrectomized eyes have a higher incidence of complications related to postoperative leakage, possibly due to the lack of plugging effect of peripheral vitreous on the unsutured sclerotomy. One should consider suturing any leaking sclerotomy at the conclusion of surgery involving previously vitrectomized eyes.     

Sutureless vitreoretinal surgery using a new 25-gauge transconjunctival system.

BACKGROUND AND OBJECTIVE: To evaluate the efficacy of vitreoretinal surgery using a new 25-gauge transconjunctival sutureless vitrectomy system. PATIENTS AND METHODS: Forty-one eyes of 41 consecutive patients were treated from July 2003 to October 2003. Diagnoses included diabetic vitreous hemorrhage (n = 19), diabetic tractional retinal detachment (n = 4), diabetic macular edema (n = 2), macular hole (n = 3), epiretinal membrane (n = 2), branch retinal vein occlusion (n = 3), central retinal vein occlusion (n = 1), vitreous opacity (n = 4), retinal detachment (n = 1), capsular block syndrome (n = 1), and submacular hemorrhage (n = 1). The procedure was combined with phacoemulsification in 14 eyes. RESULTS: All except 3 patients were operated on under retrobulbar anesthesia only. Four cases required the superior sclerotomy to be converted to a 20-gauge procedure. The mean operation time was 33 minutes and the mean balanced salt solution used was 59 cc. The mean visual acuity improved rapidly during 3 to 4 weeks following 25-gauge transconjunctival sutureless vitrectomy from 20/275 to 20/125, and then to 20/100 during the subsequent 5 months. Transient hypotony occurred in only 1 eye. Neither wound leakage nor infection was identified. CONCLUSION: Despite some limitations in surgical indications, 25-gauge transconjunctival sutureless vitrectomy appeared to increase the efficiency of vitrectomy and to facilitate postoperative visual recovery in various vitreoretinal diseases.     

Repair of primary rhegmatogenous retinal detachment using 25-gauge transconjunctival sutureless vitrectomy

PURPOSE:: To evaluate the anatomical and visual outcomes of primary rhegmatogenous retinal detachment repairs performed using 25-gauge transconjunctival sutureless vitrectomy. METHODS:: A retrospective, noncomparative interventional case series including 53 consecutive eyes of 52 patients who underwent 25-gauge transconjunctival sutureless vitrectomy to repair primary rhegmatogenous retinal detachment was performed. Variables collected for the study were patient demographics, lens status, preoperative visual acuity, and macular status. Outcome measures included single-operation anatomical success rate, final anatomical success rate, postoperative visual acuity, and surgical complications. RESULTS:: The retina was reattached with a single operation in 39 (74%) of 53 eyes. The final anatomical success rate was 100%. The mean time to redetachment was 72 days (range, 13-334 days). Proliferative vitreoretinopathy (64%) and development of new retinal breaks (43%) were the most common reasons associated with redetachment. Mean visual acuity improved from 20/100 to 20/60 (P = 0.001); 55% of eyes had final vision of 20/40 or better. Three eyes (6%) developed postoperative choroidal hemorrhage. Three eyes (6%) developed visually significant macular pucker that required surgery. No postoperative hypotony or endophthalmitis was observed. CONCLUSIONS:: Repair of primary rhegmatogenous retinal detachments using 25-gauge transconjunctival sutureless vitrectomy resulted in excellent final anatomical success rate and postoperative visual outcomes. However, redetachments due to new tears and/or proliferative vitreoretinopathy resulted in a lower single-operation success rate than those reported with 20-gauge systems.     

Visual outcomes with 23-gauge transconjunctival sutureless vitrectomy

PURPOSE: To evaluate the outcomes of patients treated with 23-gauge transconjunctival sutureless vitrectomy for various posterior segment conditions. METHODS: A retrospective chart review of 81 consecutive 23-gauge vitrectomy cases done by a single vitreoretinal surgeon for various posterior segment conditions was done. All surgery was performed using the two-step 23-gauge system developed by Dutch Ophthalmic Research Center. All patients had at least 3-month follow-up. Main outcome measures included visual acuity, intraocular pressure, and operative complications. RESULTS: Mean follow-up was 6.5 months (range 3-9 months). Mean overall preoperative visual acuity was 20/150 and final acuity was 20/70 (P < 0.0001). Mean intraocular pressure on postoperative day 1 was 14 mmHg (range 6-28 mmHg). There was a single case of intraoperative retinal tear that required treatment with cryotherapy. Twenty eyes of 48 phakic eyes (42%) had worsening of cataracts in the postoperative period. There were no postoperative complications of endophthalmitis or retinal detachment. CONCLUSIONS: Twenty-three-gauge transconjunctival sutureless vitrectomy is an effective surgical technique in the management of vitreoretinal diseases. Complications were rare and compared favorably with published literature on 20-gauge and 25-gauge surgery.     

Suprachoroidal hemorrhage caused by breakage of a 25-gauge cannula

A 72-year-old woman had vitreous surgery for epiretinal membrane using the 25-gauge vitrectomy system. During the removal of the cannula at the end of the surgery, half of its tip was noted to be missing. The following day, a severe choroidal detachment associated with a hypotony was found. A second surgery was performed, including drainage of suprachoroidal hemorrhage and choroidal fluid and the removal of the tip of the 25-gauge cannula stuck inside the sclerotomy. The retained cannula tip might have acted as a channel allowing vitreous fluid into the suprachoroidal space, resulting in choroidal detachment, hemorrhage, and hypotony.     

25-gauge cannula system with microvitreoretinal blade trocar

PURPOSE: To report a 25-gauge trocar-cannula that enhances wound closure and reduces the incidence of postoperative hypotony. DESIGN: Development of surgical instruments. METHODS: A 25-gauge cannula with a microvitreoretinal (MVR) blade trocar was constructed. The resistance of inserting this trocar cannula was compared with that of the conventional 25-gauge trocar cannula (Alcon Laboratories; Fort Worth, Texas, USA). Vitreous surgery was performed on 55 eyes with the trocar cannula with an oblique sclerotomy incision, and the results were compared with those from 68 eyes that underwent surgery with the conventional trocar cannula. RESULTS: The resistance of inserting the trocar cannula was less than that with the conventional trocar cannula. A temporary hypotony (intraocular pressure [IOP] <6 mm Hg) was found in one eye (2%) with the trocar cannula and in 12 eyes (18%) with the conventional trocar cannula (P = .006, Fisher exact probability test). CONCLUSIONS: The trocar cannula with a MVR blade was effective in postoperative wound closure and prevention of postoperative hypotony.     

Hypotony after 25-gauge vitrectomy using oblique versus direct cannula insertions in fluid-filled eyes

PURPOSE: To compare intraocular pressure (IOP) and rates of postoperative hypotony with 25-gauge pars plana vitrectomy (PPV) without tamponade using oblique versus direct cannula insertions. METHODS: A prospective consecutive series of eyes that underwent 25-gauge PPV without tamponade using an oblique cannula insertion technique was compared with a historical consecutive series of eyes that underwent 25-gauge PPV without tamponade using direct cannula insertions. IOP was recorded before surgery, on postoperative day 1, and on postoperative week 1. RESULTS: Ninety-five eyes had 25-gauge PPV without tamponade, 55 with oblique cannula insertions and 40 with direct insertions. With oblique insertions, there was no statistically significant difference between mean IOPs measured before surgery, on postoperative day 1, and on postoperative week 1. Only 1 (1.8%) of the 55 eyes had hypotony (IOP, 相似文献   

25-G玻璃体手术系统在儿童白内障手术中的应用

目的 探讨儿童白内障手术中在无灌注状态下应用25-G玻璃体切除头切除视轴区晶状体后囊膜和玻璃体前皮质的安全性和有效性.方法 为前瞻性系列病例研究.对连续30例(40只眼)儿童白内障在全身麻醉下进行晶状体前囊环形撕开、白内障吸出和囊袋内折叠式人工晶状体(IOL)植入后,在前房保留黏弹剂的状态下,经扁平部应用25-G玻璃体切除头行视轴区晶状体后囊膜切开和前玻璃体皮质切除.观察记录手术切除时间、眼压变化、穿刺口愈合情况、手术并发症和手术疗效.结果 所有手术均顺利进行,术中无前房塌陷、晶状体后囊膜撕裂和其他并发症,IOL均位于囊袋内.视轴区后囊膜切开和玻璃体前皮质切除的时间为20～60 s,平均(38.8±11.2)s.有2只眼术后发生短暂低眼压,均在3 d内恢复正常,其余患儿术后眼压在正常范围.术后2只眼前房出现轻度纤维性渗出,在术后37～d完全吸收.超声活体显微镜显示巩膜穿刺口在术后1个月左右痊愈.随访时间4～30个月,平均8个月.所有患儿瞳孔均圆而居中,无虹膜后粘连、后囊膜切开区混浊、IOL偏位或夹持、玻璃体脱出、视网膜脉络膜脱离及增生性玻璃体视网膜病变发生.结论 在儿童白内障手术中利用25-G玻璃体切除头在无灌注状态下行视轴区晶状体后囊膜切开和玻璃体前皮质切除术安全有效,手术创伤小,操作容易控制,术后炎症反应轻.长期疗效及与其他手术方式疗效的比较还需进一步观察.     

Comparison of clear corneal phacoemulsification combined with 25-gauge transconjunctival sutureless vitrectomy and standard 20-gauge vitrectomy for patients with cataract and vitreoretinal diseases

PURPOSE: To compare effectiveness and outcomes of clear corneal phacoemulsification combined with 25-gauge transconjunctival sutureless vitrectomy and standard 20-gauge vitrectomy system for patients with clinically significant cataract and vitreoretinal diseases. SETTING: Department of Ophthalmology, Tri-Service General Hospital, Taipei, Taiwan, Republic of China. METHODS: Clear corneal phacoemulsification combined with 25-gauge transconjunctival sutureless vitrectomy was performed in the study group (15 eyes). Patients in the control group (15 eyes) had combined surgery with clear corneal phacoemulsification and the existing 20-gauge vitrectomy system, providing a comparison between 2 groups with regard to preoperative and postoperative best corrected visual acuity (BCVA), intraocular pressure, and intraoperative and postoperative complications. The additional outcome measurements in both groups were duration of the surgical procedures, time to return to preoperative corneal clarity, time to achieve stable vision, and subjective ocular irritation postoperatively. RESULTS: Postoperatively, BCVA improved in 12 eyes (80%) in the study group and in 11 eyes (73.3%) in the control group. Mean operative time for opening and closing the sclerotomy was significantly greater in the control group than in the study group. Time to return to preoperative corneal clarity and time to achieve stable vision showed no significant difference between the groups. Compared with the control group, postoperative ocular irritation in patients in the study group was considerably reduced. CONCLUSIONS: Combined sutureless surgery needed shorter setup time for sclerotomy and caused less postoperative ocular irritation than combined surgery with 20-gauge vitrectomy. Therefore, this type of procedure would be a good option for selected cases with cataract and vitreoretinal diseases.     

23G微创玻璃体切割术在孔源性视网膜脱离中的应用

目的：评估23G经结膜无缝线玻璃体切割手术治疗孔源性视网膜脱离的安全性及有效性。 方法：前瞻性选择2010-03/2011-06共26例26眼不伴有严重增生性病变的孔源性视网膜脱离病历,均行23G切割手术。记录术前、术后的最佳矫正视力（BCVA）、眼压,术中及术后并发症。 结果：一次性复位视网膜21例（81%）,最终复位视网膜25例（96%）。术后3mo最佳矫正视力较术前提高21例（80%）,不变3例（12%）,下降2例（8%）。术后1d眼压较术前下降,此差异有统计学意义（P<0.01）。低眼压（≤6mmHg）2例,持续2wk,但未发生脉络膜脱离。 结论：23G手术治疗孔源性视网膜脱离解剖复位率满意,术后视力改善明显。但23G微创手术的优势并没有在孔源性视网膜脱离的手术中得到充分体现,反而要面临更高的手术失败的风险。     

Removal of silicone oil with 25-gauge transconjunctival sutureless vitrectomy system

PURPOSE: To report a new and simple technique for silicone oil removal from pars plana with 25-gauge (G) transconjunctival sutureless vitrectomy system (TSVS). METHODS: In this prospective, interventional clinical trial, 13 eyes underwent silicone oil (1000 centistokes) removal from pars plana passively, with 25-G TSVS, between January and May 2005. Main outcome measures were postoperative visual acuity, intraocular pressure (IOP), silicone oil removal time, complications, and number of sutured sites. RESULTS: In all eyes silicone oil was removed successfully under sub-Tenon (n = 12) and topical (n = 1) anesthesia. The mean silicone oil removal time was 7.27 +/- 0.48 minutes. No intraoperative complications were reported. No suture placement was necessary. Mean postoperative follow-up period was 3.92 +/- 1.49 (range: 3-7) months. Visual acuity improved or stabilized in 11 (84.61%) eyes. Retinal redetachment occurred in 2 (15.38%) eyes resulting in a decrease in vision. Decrease in postoperative IOP was found only at 2 hours (P = 0.003). Postoperatively, transient hypotony at 2 hours (n = 1) and transient vitreous hemorrhage (n = 1) were noted. There were no cases of choroidal detachment, endophthalmitis, clinically significant corneal endothelial decompensation, or macular edema. CONCLUSION: Removal of silicone oil of 1000 centistokes with 25-G transconjunctival sutureless sclerotomies was effective and safe.     

Outcomes of transconjunctival sutureless 27-gauge vitrectomy for vitreoretinal diseases

AIM: To evaluate the safety and efficacy profile of 27-gauge (27G) pars plana vitrectomy (PPV) for the treatment of various vitreoretinal diseases. METHODS: The clinical outcomes of 61 eyes (58 patients) with various vitreoretinal diseases following 27G PPV were retrospectively reviewed. RESULTS: Surgical indications included rhegmatogenous retinal detachment (n=24), full-thickness macular hole (n=12), diabetic retinopathy (n=11), vitreous hemorrhage (n=6), Eales disease (n=4), pathological myopia-related vitreous floater (n=2), and macular epiretinal membrane (n=2). The mean follow-up was 166.4±61.3d (range 98-339d). The mean logMAR best-corrected visual acuity (BCVA) improved from 1.7±1.1 [0.02 decimal visual acuity (VA) equivalent] preoperatively to 1.2±1.0 (0.06 decimal VA equivalent) at the last postoperative visit (P<0.001). The mean operative time was 49.9min. With the exception of complicated cataract in one eye, no intraoperative complications were encountered. No case required conversion to conventional 20-, 23- or 25G instrumentation in all surgical maneuvers except for silicone oil infusion, which required a 25G oil injection syringe. Postoperative complications included transient ocular hypertension, vitreous hemorrhage, persistent intraocular pressure elevation, subconjunctival oil leakage, and recurrent retinal detachment. No cases of hypotony, endophthalmitis, and sclerotomy-related tears were observed. CONCLUSION: The current results suggest that 27G PPV system is a safe and effective treatment for various vitreoretinal diseases. When learning to perform 27G PPV, surgeons may encounter a learning curve and should gradually expand surgical indications from easy to pathologically complicated cases.     

25-gauge transconjunctival sutureless vitrectomy system in the surgical management of children with posterior capsular opacification

PURPOSE: To evaluate the safety and efficacy of the 25-gauge transconjunctival sutureless vitrectomy (TSV) system in the surgical management of posterior capsular opacification (PCO) in pseudophakic children. METHODS: Pars plana membranectomy was performed for PCO in 10 pseudophakic eyes of six children (mean age 35.1 +/- 37.8 months; range 6-93 months) using the TSV system. Surgical technique, intraoperative problems and postoperative complications including wound leakage, hypotony and the need for suturing were recorded. RESULTS: Wound leakage and other intraoperative problems were not noted in any of the eyes. All eyes showed improvement of visual acuity from a mean of 6/67 before to 6/29 after surgery (P = 0.001). Mean postoperative intraocular pressure (IOP) was 7.8 +/- 3.1 mmHg (range: 3-10 mmHg). Four eyes (40%) had hypotony on the first postoperative day (IOP: 3-5 mmHg), which was transient in three eyes. One eye in a patient with uveitis had persistent hypotony, but hypotony was also present preoperatively, and the postoperative IOP returned to preoperative levels. This eye also developed recurrent PCO and a second capsulotomy was performed using the 25-gauge TSV system. CONCLUSIONS: Posterior capsulotomy using the 25-gauge TSV system appears to be a safe and effective approach in the management of PCO in pseudophakic children. Advantages include easier manipulation with the smaller instruments in these small eyes, and it can be considered in appropriate cases.     

Outcomes of transconjunctival sutureless 25-gauge vitrectomy with silicone oil infusion

PURPOSE: To evaluate the outcomes and complications of surgical management with 25-gauge pars plana vitrectomy (PPV) and silicone oil (SO) tamponade in complex vitreoretinal diseases. METHODS: Retrospective review of a consecutive, interventional case series at a single center. RESULTS: Thirty-five eyes of 35 patients were included in the study. The indications for vitrectomy included tractional retinal detachment (11 eyes), macular hole (6 eyes), proliferative vitreoretinopathy or recurrent retinal detachment (9 eyes), neovascular glaucoma (3 eyes), giant retinal tear (3 eyes), and pathologic myopia with epiretinal membrane or macular hole (3 eyes). All patients underwent 25-gauge PPV with either 1,000-centistoke (n = 31) or 5,000-centistoke (n = 4) SO tamponade infused through a 24-gauge angiocatheter. No intraoperative complications were noted. The median preoperative visual acuity was counting fingers (range, 20/50 to light perception). The median postoperative visual acuity after a median follow-up of 6 months (range, 1-19 months) was 20/200 (range, 20/30 to light perception). A small subconjunctival SO bleb was identified in two patients. Recurrent retinal detachment occurred in three patients. No significant complications relating to the use of SO in the setting of 25-gauge PPV occurred. CONCLUSIONS: Advances in 25-gauge PPV instrumentation have enabled expanding indications for 25-gauge PPV. 25-Gauge PPV with SO tamponade is safe and efficient and can be considered in the surgical management of complex vitreoretinal disease.     

Comparison of 25-gauge sutureless vitrectomy and 20-gauge vitrectomy in the treatment of posterior capsule opacification in pseudophakic children

AIM: To compare the effectiveness and safety of pars plana capsulotomy and vitrectomy using 25-gauge tansconjunctival sutureless vitrectomy system and 20-gauge vitrectomy system for posterior capsule opacification (PCO) in pseudophakic children. METHODS: Retrospectively study. Pars plana capsulotomy and vitrectomy using 25-gauge sutureless vitrectomy system was performed for PCO in the study group (32 eyes). Patients in the control group (34 eyes) underwent capsulotomy and vitrectomy using standard 20-gauge vitrectomy system, providing a comparison between 2 groups with regard to preoperative and postoperative best corrected visual acuity (BCVA), intraocular pressure (IOP), and intraoperative and postoperative complications. The two groups were performed consequentially. The patients ages ranged from 2 to 13y (means: 6.61±2.73y). Surgical technique, intraoperative and postoperative complications, visual acuity, IOP, and recurrent PCO were recorded. RESULTS: The surgical procedure was performed uneventfully in all patients. Visual acuity improved significantly in both groups. BCVA improved in 22 eyes (81.5%) in the study group and in 28 eyes (87.5%) in the control group. There was no statistical difference of visual acuity that were attainable in two groups (H=0.115, P=0.909). Mean postoperative IOP showed no significant difference between the groups at 1wk. All sort of PCO were accomplished by 20-gauge system, while 25-gauge system was effective for pearls style and 2 grade of fibrous PCO, and was insufficient to grade 3 of PCO. In the study group two cases were not accomplished by 25-gauge system while 20-gauge system conquered them. Compared with the control group, mean operative time for opening and closing the sclerotomy in the study group was considerably reduced. The mean follow-up was 38.2mo (range: 8-79mo). During the follow-up period, no incision leakage, corneal edema, vitreous loss, IOL damage, retinal detachment, recurrent PCO, or other complications were noted. CONCLUSION: Pars plana capsulotomy and vitrectomy using 25-gauge transconjunctival sutureless vitrectomy appeared to be a safe and effective approach for PCO in pseudophakic children. Combined sutureless surgery needed shorter setup time for sclerotomy and caused less surgical trauma than combined surgery with 20-gauge vitrectomy. Therefore, this type of procedure would be a good option for selected cases with PCO in pseudophakic children.     

Two-step oblique incision during 25-gauge vitrectomy reduces incidence of postoperative hypotony

The efficacy of a two-step, oblique incision procedure during 25-gauge vitrectomy on postoperative hypotony was evaluated by a retrospective, case-control study. The transconjunctival incision during 25-gauge vitrectomy was made in two steps: penetration with a microvitreoretinal blade followed by a penetrater instrument of a blunt trocar. The two-step procedure was performed on 89 eyes and with the conventional incision on 68 eyes. The incidence of hypotony (intraocular pressure <6 mmHg) on the first postoperative day and after 1 week and 1 month was compared. Hypotony was found in two eyes (2%) with the two-step method and 12 eyes (18%) with the conventional incision on the first postoperative day (P = 0.001, Fisher's exact probability test). The preoperative intraocular pressure was not significantly different in the two groups but was significantly higher in the two-step group than in the conventional method group on the first postoperative day (P = 0.001, Wilcoxon rank test). Twenty-five-gauge vitrectomy with two-step oblique incisions will reduce the incidence of postoperative hypotony on the first postoperative day.     

Glaucoma filtering surgery with postoperative 5-fluorouracil in patients with intraocular inflammatory disease.

Twenty-one eyes of 18 patients with uncontrolled glaucoma and intraocular inflammatory disease had glaucoma filtering surgery with postoperative subconjunctival 5-fluorouracil (5-FU). Follow-up for eyes in which intraocular pressure was controlled ranged from 6 to 53 months (mean, 34 months; median, 35 months). Fifteen of 21 eyes (71%) had controlled intraocular pressure (21 mmHg or less). Control was achieved in 9 of 10 (90%) phakic eyes and in 6 of 11 (55%) aphakic or pseudophakic eyes with or without glaucoma medication. Four of six filter failures had a second filtering procedure with 5-FU, and of these four procedures, three were successful. Cataract progression occurred in 9 of 10 phakic eyes, leading to cataract surgery in 7 eyes. Other complications included corneal epithelial defects in 13 eyes, bleb leaks in 3 eyes, choroidal effusions in 13 eyes, 1 choroidal hemorrhage, 1 serous retinal detachment and macular retinal pigment epithelial disturbance associated with hypotony and choroidal effusion. Filtering surgery with postoperative subconjunctival 5-FU can successfully control intraocular pressure in eyes with ocular inflammatory disease.