Comparison of postoperative intraocular pressure changes between 23-gauge transconjunctival sutureless vitrectomy and conventional 20-gauge vitrectomy

Purpose

To compare the intraocular pressure (IOP) after 23-gauge transconjunctival sutureless vitrectomy (TSV) and conventional 20-gauge vitrectomy for various vitreoretinal diseases.

Methods

This was a retrospective interventional case series including 338 cases of 23-gauge TSV and 476 cases of 20-gauge vitrectomy with minimum follow-up period of 1 month. Postoperative 1 day, 1 week and 1 month IOPs were compared. Multiple regression analysis to assess the actual effect of gauge of vitrectomy on postoperative IOP was performed including intraoperative and postoperative factors influencing postoperative IOP as covariates.

Results

The mean IOP of 20-gauge vitrectomy was significantly higher than that of 23-gauge TSV (20.6±8.02 mm Hg vs12.8±4.48 mm Hg, P<0.001) at postoperative day 1, but the differences were not significant at postoperative 1 week and 1 month. The IOP pattern of 23-gauge TSV demonstrated more stable course than that of 20-gauge vitrectomy. At 1 day post vitrectomy, the incidence of hypertony was higher in 20-gauge, whereas that of hypotony was higher in 23-gauge. Among risk factors, the 20-gauge vitrectomy showed the strongest association with postoperative 1 day IOP rise.

Conclusion

Twenty-three-gauge TSV has stable and lower IOP in the early postoperative period than the 20-gauge vitrectomy. In patients whose retina and optic nerves are vulnerable to higher or fluctuating IOP, 23-gauge TSV may be more beneficial.     

Conjunctival pigmentation after 23-gauge microincisional vitrectomy surgery

Aim

To investigate cases with conjunctival pigmentation originating from sclerotomy sites after 23-gauge microincisional vitrectomy surgery (MIVS).

Methods

This is a retrospective study comprised of 185 eyes from 185 consecutive patients who underwent 23-gauge MIVS. The authors investigated the incidence and the clinical factors associated with conjunctival pigmentation, including indication of vitrectomy and surgical procedures.

Results

Eight eyes (4.3%) from 185 eyes showed conjunctival pigmentation after surgery within 7 days postoperatively. Light microscopic examination of excised tissue showed infiltration of abundant dark brownish colored melanophages with surrounding scattered, finely granular, melanin pigments. C3F8 gas tamponade (OR, 9.4; 95% CI, 1.9–44.5; P=0.005) was significantly associated with conjunctival pigmentation. The mean surface area (21.26±2.21 mm²) of three eyes with C3F8 tamponade was significantly larger than that of five eyes (2.51±0.73 mm²) without tamponade (P=0.025). Neither leakage nor hypotony was found.

Conclusions

Intraocular melanin pigments could prolapse through the sclerotomy site and cause conjunctival pigmentation after 23-gauge MIVS. Thus, preoperative warning is necessary in patients with 23-gauge MIVS.     

Surgical outcomes of transconjunctival sutureless 23-gauge vitrectomy with silicone oil injection

Aims

To evaluate the outcomes and complications of 23-gauge transconjunctival sutureless vitrectomy (TSV) with Silicone oil (SO) tamponade in complex vitreoretinal diseases.

Settings and Design

Ege university hospital ophthalmology department. Retrospective case series.

Materials and Methods

Forty eyes of 40 patients with diabetic tractional retinal detachment (DTRD) and proliferative vitreoretinopathy (PVR) were included in the study. Vitrectomy using 23-gauge system with SO endotamponade was performed. Peroperative and postoperative complications, anatomical and visual results were evaluated.

Statistical analysis used

Paired Student''s t-test.

Results

Simultaneous cataract surgery was performed in 17 eyes. Peroperative complications were posterior capsule rupture during phacoemulsification in one patient, vitreous and retinal incarceration in one patient. One eye required suture placement at the end of surgery due to SO leakage. Postoperatively, a small subconjunctival SO bubble in three patients, and hypotony in one patient (6 mmHg) were observed. Recurrent retinal detachment under SO occurred in one patient. Mean follow-up was 6.5 months (±2.7). Pre- and postoperative mean visual acuity was 2.22±0.91 logMAR and 1.11±0.8 logMAR, respectively (P<0.001). Mean intraocular pressure (IOP) on the first postoperative day was lower than preoperative IOP (11.3 ±3.2 versus 14.0 ±2.4 mmHg) (P<0.001).

Conclusions

Twenty-three gauge instrumentation seems to be feasible, effective and safe for vitrectomy with SO injection in DTRD and PVR, and can be considered in the surgical management of these complex vitreoretinal diseases.     

Posterior capsule opacification following 20- and 23-gauge phacovitrectomy (posterior capsule opacification following phacovitrectomy)

Purpose

To compare the development of posterior capsule opacification (PCO) for idiopathic epi-retinal membrane cases between 20- and 23-gauge phacovitrectomy.

Methods

Cataract surgery of phacoemulsification with the SA60AT implantation and 20- or 23-gauge vitrectomy was performed for 20 patients in both groups. Cataract surgery alone was performed for 50 patients as the control. The PCO density values were measured using Scheimpflug video photography at 1 week, 1, 3, 6, 12, 18, and 24 months after surgery. The number of eyes that required Nd:YAG laser capsulotomy was also examined.

Results

The mean PCO value in the 20-gauge phacovitrectomy group increased significantly with time (P<0.001), whereas those in the 23-gauge phacovitrectomy group and the cataract surgery group did not show any significant change. Furthermore, the PCO value in the 20-gauge phacovitrectomy group was significantly greater than that in the 23-gauge phacovitrectomy group at 6, 12, 18 (P<0.05), and 24 months (P<0.01) after surgery. The PCO value in the 23-gauge phacovitrectomy group was significantly greater than that in the cataract surgery group 24 months after surgery (P<0.05). The rate of capsulotomy in the 20-gauge phacovitrectomy group was significantly higher than that in the cataract surgery group (P=0.007), whereas there was no significant difference between the 23-gauge phacovitrectomy group and the cataract surgery group.

Conclusion

PCO rate in eyes with the 23-gauge phacovitrectomy was lower than in those with the 20-gauge phacovitrectomy, and PCO rate even in the 23-gauge phacovitrectomy was higher than in those with cataract surgery.     

The incidence and the risk factors for iatrogenic retinal breaks during pars plana vitrectomy

Purpose

To establish the frequency and the risk factors for iatrogenic retinal breaks during three-port pars plana vitrectomy (PPV).

Methods

A total of 2471 PPV operations were included in the study. The study period was between 2001 and 2010, all the data were entered in an electronic patient record database. All 270 consecutive eyes of 270 patients developing iatrogenic retinal breaks during primary PPV were matched to 270 controls. Univariate and multivariate analysis were performed to establish the risk factors.

Results

The median age of the patients with iatrogenic breaks was 60.06 years; male to female ratio was 140/130. The overall frequency of iatrogenic retinal breaks was 10.09%. The frequency of iatrogenic retinal breaks for eyes undergoing PPV for tractional retinal detachment (TRD) was 32.45%. The lens status was phakic in 79.6% of the eyes, with iatrogenic breaks compared with 34.4% of the eyes in control group (P<0.001). Posterior vitreous was attached in 58.9% of the eyes with iatrogenic breaks compared with 50.4% of the eyes in control group (P=0.04). Internal limiting, epiretinal, proliferative, or fibrovascular membrane removing manoeuvers were performed in 71.1% of the eyes with iatrogenic breaks compared with 61.9% of the eyes in control group (P=0.052).

Conclusion

Eyes undergoing PPV for TRD had significantly higher frequency of iatrogenic retinal breaks compared with other subgroups (P=0.0001). Phakia and absence of PVD were found to be risk factors for iatrogenic retinal breaks.     

Combined 23-gauge microincisonal vitrectomy surgery and phacoemulsification with AcrySof toric intraocular lens implantation: a comparative study

Aim

To compare AcrySof toric intraocular lens (IOL) and non-toric IOL in patients who had combined 23-gauge microincisional vitrectomy surgery (MIVS) and phacoemulsification for vitreoretinal diseases and cataract with pre-existing corneal astigmatism.

Methods

This is a prospective comparative study comprised of 30 patients (30 eyes) who had combined 23-gauge MIVS and phacoemulsification for vitreoretinal diseases and cataract with pre-existing regular corneal astigmatism greater than 1 diopters (D). In all, 15 eyes had AcrySof toric IOL (Alcon Laboratories) and 15 eyes had non-toric IOL (Akreos AO MI60; Bausch & Lomb) implantation. Main outcome measures were uncorrected visual acuity (UCVA), refractive cylinder, surgically induced astigmatism (SIA), and IOL misalignment during 6 months.

Results

The mean UCVA of the toric IOL group was better than the non-toric IOL group at postoperative months 1, 3, and 6 (P<0.001, respectively). The mean absolute residual refractive cylinder of the toric IOL group at postoperative week 1, and months 1, 3, and 6 was less than the non-toric IOL group (P=0.008, <0.001, <0.001, and <0.001, respectively). There was no difference in the mean SIA between the two groups (P>0.05, respectively). The mean toric IOL axis rotation was 3.52±2.75°, which was within 5° in 66.7% of the toric IOL group and within 10° in 100%.

Conclusions

Combined 23-gauge MIVS and phacoemulsification with AcrySof toric IOL implantation is an effective method of correcting vitreoretinal diseases and cataract and pre-existing corneal astigmatism, and the toric IOL showed good rotational stability, even in vitrectomized eyes for 6 months.     

Effect of intravitreal bevacizumab injection before vitrectomy on proliferative diabetic retinopathy

AIM: To evaluate the effect of intravitreal bevacizumab (IVB) injection 1 week before pars plana vitrectomy (PPV) in proliferative diabetic retinopathy (PDR) patients. METHODS: A retrospective research was done on 46 PDR patients who were divided into PPV group (n=28) and IVB group (n =18, PPV with preoperative IVB). Bevacizumab was injected 1 week before PPV. Main outcome measures were visual acuity, incidence of iatrogenic retinal breaks, intraoperative and postoperative bleeding. RESULTS: At 1 month after surgery, visual acuity in PPV (82.1%) and IVB group (88.9%) improved significantly (P＜0.01) and the difference between the two groups was not significant (P＞0.05). Iatrogenic retinal breaks were reported in 18 cases (64.3%) in PPV group and 4 cases (22.2%) in IVB group (P＜0.05). Intraoperative bleeding was encountered in all cases in PPV group and 7 cases (39%) in IVB group (P＜0.01). Postoperative bleeding was reported in 9 cases (32.1%) in PPV group and none in IVB group (P＜0.01). CONCLUSION: IVB injection before PPV is helpful in reducing iatrogenic retinal breaks, intraoperative and postoperative bleeding in PDR patients.     

Combined 23-gauge sutureless vitrectomy and clear corneal phacoemulsification for rhegmatogenous retinal detachment repair

AIM: To assess the outcomes of combined 23-gauge sutureless vitrectomy and clear corneal phacoemulsification with intraocular lens implantation for rhegmatogenous retinal detachment (RRD) repair. METHODS: This was a retrospective, consecutive, non-comparative, interventional case series of 30 eyes of 30 patients who underwent combined sutureless vitrectomy and clear corneal cataract surgery for the repair of RRD. The principal outcome measures were primary anatomical success rate, reasons for redetachment, final visual acuity, and surgical complications. RESULTS: Primary reattachment was achieved in 27 eyes (90.0%). The reasons for redetachment (3 eyes, 10%) were incomplete laser retinopexy, persistent chronic subretinal fluid, and proliferative vitreoretinopathy, respectively. The logarithm of the minimum angle of resolution visual acuity (mean±SD) improved from 0.76±0.74 preoperatively to 0.21±0.37 6 months’ postoperatively (P<0.0001). Postoperative hypotony was not detected, but 1 eye (3.3%) had increased intraocular pressure (30mmHg) with spontaneous resolution. No endophthalmitis developed during follow-up. Macular pucker was detected in 3 eyes (10.0%). CONCLUSION: Combined 23-gauge sutureless vitrectomy and clear corneal phacoemulsification with intraocular lens implantation for RRD repair was proven safe and effective. It may provide not only the known advantages of conventional combined surgery, but also additional advantages such as less conjunctival fibrosis and the maintenance of stable intraocular pressure with low risks of postoperative hypotony and intraocular pressure elevation.     

23- vs 20-gauge pars plana vitrectomy in combination with bimanual microincisional cataract surgery (b-MICS) for the treatment of macular hole and cataract as a one-step procedure

Background/aims

23-gauge pars plana vitrectomy (ppv) is a new method for vitreo-retinal surgery. It may reduce operation time, the risk of complications, and patient discomfort, especially in combination with simultaneous bimanual microincisional cataract surgery (b-MICS).

Methods

Seventy-five consecutive patients who underwent combined cataract surgery and ppv at our center between 1 January 2008 and 31 December 2010 were included. The first 36 patients were treated with 20-gauge ppv, the following 39 patients with 23-gauge ppv. Study end points 8 weeks after surgery were duration of the procedure, improvement of visual acuity, and occurrence of complications.

Results

Duration of surgery was reduced in 23- vs 20-gauge ppv (54.0±11.6 vs 61.0±19.0 min, P=0.08). Visual acuity improved significantly in both the groups (20-gauge: logMAR 0.750±0.304 before and 0.369±0.273 after surgery; 23-gauge: logMAR 0.663±0.340 before and 0.339±0.273 after surgery). There were no appreciable group differences in baseline or post-treatment visual acuity.

Conclusions

23-gauge ppv in combination with b-MICS is a suitable, safe, and effective method for the treatment of combined cataract and vitreo-retinal diseases. The procedure is somewhat shorter and patient discomfort during and after surgery is improved. In terms of efficacy and safety, 23-gauge ppv is equivalent with conventional 20-gauge ppv.     

Clinical presentation of a mixed 23-gauge infusion and 20-gauge pars plana technique for active silicone oil removal

AIM: To present with a clinical case series of a mixed 23-gauge infusion and 20-gauge pars plana technique for 5,700-centipoise silicone oil removal (SOR), and to discuss its efficacy and safety.METHODS: This is a retrospective, non-randomized controlled study. We performed SOR with 23-gauge infusion and 20-gauge active suction technique on 29 patients 29 eyes from April to October, 2011 (mixed group). During the surgeries, a 23-gauge sclerotomy was made for infusion and a 20-gauge sclerotomy was used for active silicone oil suction. Anterior segment optical coherence tomography (OCT) was applied for 23-gauge sclerotomy analysis 1 day post-operation. Traditional 20-gauge SOR was performed on another consecutive 29 patients 29 eyes, the control group (20G group).RESULTS: There were 2 eyes (6.9%) in mixed group and 5 eyes (17.2%) in 20G group which had recurrent retinal detachment after surgery. Hopytony (IOP≤6mmHg) occurred in 8 eyes (27.6%) of mixed group and in 10 eyes (34.5%) of 20G group post-operation, but all of them recovered to the normal level finally. There were no statistical significant differences. Final visual acuity was significantly increased after surgery in both groups. Anterior segment OCT images were acquired from 13 eyes of mixed group, and all of them had a proper wound apposition. But local ciliary detachment was found in 9 eyes (69%). It was hard to define the OCT image of the sclerotomies and ciliary body because of the serious conjunctival hemorrhages and chemosis in 20G group.CONCLUSION: This mixed technique is a convenient and effective way to remove high viscosity silicone oil. Compared with traditional 20-gauge SOR, it does not increase the risk of post-operative complications and has less conjunctival reactions.. Transient postoperative hypotony is common for this procedure and subclinical ciliochoroidal detachment is a probable cause.     

Non-buckled vitrectomy for retinal detachment with inferior breaks and proliferative vitreoretinophathy

AIM: To investigate the efficacy of non-buckled vitrectomy with classical endotamponade agents in the treatment of primary retinal detachment (RD) complicated by inferior breaks and proliferative vitreoretinophathy (PVR).METHODS: A retrospective, consecutive and case series study of 40 patients with inferior break RD and PVR ≥C1 was conducted. All patients underwent a standard 3-port 20-gauge pars plana vitrectomy (PPV) with gas or silicone oil tamponade without supplementary scleral buckling. The vitreous and all proliferative membrane were completely removed, and retinectomy was performed when necessary. The mean follow-up was 12.5 months. The primary and final anatomic success rate, visual acuity and complications were recorded and analyzed.RESULTS: Primary anatomic success rate was achieved in 35 of 40 eyes (87.5%) and the final anatomic success rate was 100%. The most common cause of redetachment was recurrent PVR. The best-corrected visual acuity (BCVA) at final follow-up was improved in 34 eyes (85%), remained stable in 1 eye (2.5%), and worsened in 5 eyes (12.5%). The mean visual acuity at final follow-up was improved significantly (P=0.000).CONCLUSION: This retrospective study provides evidence that vitrectomy without scleral buckling seemed to be an effective treatment for inferior break RD with PVR. With complete removal of vitreous and proliferative membranes and timing of retinectomy, the inferior breaks which complicated with PVR could be closed successfully without additional scleral buckling.     

Primary 23-gauge sutureless vitrectomy for rhegmatogenous retinal detachment

Aims:

To report a prospective non-comparative consecutive interventional study on the safety and efficacy of 23-Gauge transconjunctival sutureless pars plana vitrectomy for primary rhegmatogenous retinal detachment (RRD).

Materials and Methods:

Fifty eyes of 50 consecutive patients were recruited between June 2007 and January 2008. All surgeries were performed using the one-step 23-Gauge system with angled incisions. The surgical protocol consisted of a minimum of eight clinical visits: baseline, 1 day, 1 week, 1-, 3- and 6- months after the initial surgery. The endpoints were anatomical, functional results and complications arising from the surgery.

Results:

Anatomical success was achieved in 82% of cases (41 out of 50) with single surgery and rose to 98% (49 out of 50) with additional surgery. Mean visual acuity improved from logMAR 0.48(SD 0.36) to 0.26(SD 0.31), P < 0.001. Two cases with ocular hypotony, defined as an intraocular pressure ≤ 6mmHg, that were associated with a choroidal detachment were seen.

Conclusions:

Acceptable anatomical and functional success rates can be achieved with primary 23-Gauge transconjunctival sutureless vitrectomy for RRD. We found that the approach technique is different from conventional vitrectomy and the complications arising from post surgical hypotony and leakage from sclerotomies are potentially higher compared to 20-Gauge vitrectomy.     

Surgical and visual outcome following 20-gauge vitrectomy in proliferative diabetic retinopathy over a 10-year period, evidence for change in practice

Introduction

The study reports 10-year anatomical and visual outcome in patients who underwent pars plana vitrectomy (PPV) for complications due to proliferative diabetic retinopathy (PDR).

Methods

Retrospective analysis of patients undergoing 20G PPV from January 1999 to May 2010 for tractional retinal detachment (TRD) and non-clearing vitreous hemorrhage (NCVH) secondary to PDR recorded prospectively on an electronic patient record. The primary aim was to study anatomical success and eyes with visual acuity (VA) of ≤0.3 logMAR at last follow-up.

Results

There were 346 eyes of 249 patients with mean age of 55.63 years and follow-up of 1.44 years. In all, 95.3% of eyes had a flat retina at final follow-up. Overall 136/346 (39.4%) eyes had final VA of logMAR ≤0.3 (Snellen 6/12) and 129 (37.3%) had logMAR ≥1.0 (Snellen 6/60). In all, 50/181 (27.6%) eyes with TRD and 84/165 (50.9%) with NCVH achieved final VA of ≤0.3 logMAR (Snellen 6/12). A total of 218 (63.1%) showed ≥0.3 logMAR improvement from baseline to last follow-up. Both preoperative VA and final postoperative (post-op) VA (P<0.001) improved significantly with each year from 1999 to 2010. The commonest peroperative complication was iatrogenic retinal tear formation (28.4%). This was a risk factor for the development of post-op retinal detachment, odds ratio: 3.90 (95% confidence interval: 1.91–7.97, P=0.0002). Silicone oil was used in 5.2% of patients at the primary procedure. In all, 9.2% required removal of non clearing post vitrectomy hemorrhage.

Conclusions

Outcomes from vitreoretinal surgery for complications of diabetic retinopathy have improved. In addition, the visual outcome after diabetic vitrectomy steadily improved over the 10-year period, which may in part be due to the move to operate on patients with better vision.     

Comparison of Efficacy and Safety between Transconjunctival 23-Gauge and Conventional 20-Gauge Vitrectomy Systems in Macular Surgery

Purpose

To compare the efficacy and safety of 23-gauge transconjunctival vitrectomy with the conventional 20-gauge method in idiopathic epiretinal membrane and macular hole surgery.

Methods

Sixty-one consecutive patients undergoing vitrectomy for idiopathic epiretinal membrane and macular hole were recruited to either 20- or 23-gauge vitrectomy groups and prospectively evaluated. Surgical success rates, operating time, surgery-related complications, long-term visual outcomes, and postoperative ocular surface problems are compared in the two groups.

Results

There were 31 eyes in the 20-gauge group and 33 eyes in the 23-gauge group. The macular hole closure rate after the first surgery was 83% and 90.9% in the 20-gauge and 23-gauge groups, respectively, with no significant difference between groups (p = 0.59). The success rate for idiopathic epiretinal membranes cases was 100% in both groups. There was no statistically significant difference between overall surgical times (p = 0.90). None of the patients in either group experienced postoperative complications of severe postoperative hypotony, vitreous hemorrhage or endophthalmitis, except one eye in the 20-gauge group, which was found to have retinal detachment. In both groups, statistically significant improvement in visual acuity was achieved 1-month postoperatively (p = 0.002) and thereafter at all postoperative visits (p < 0.05). The mean ocular surface scores were significantly lower in the 23-gauge group at all postoperative visits compared with the 20-gauge group scores (p = 0.001).

Conclusions

Transconjunctival 23-gauge vitrectomy appears to be as effective and safe as conventional 20-gauge vitrectomy in idiopathic epiretinal membrane and macular hole surgeries.     

Partial posterior hyaloidectomy for macular disorders

Purpose

To evaluate the effect of partial posterior hyaloidectomy (PPH) in preventing iatrogenic retinal breaks related to the induction of a posterior vitreous detachment (IPVD)

Methods

Fifty-nine patients who necessitated IPVD for an epiretinal membrane or macular hole were included in this prospective, interventional case series. Extensive removal of vitreous gel, close to the retina, was conducted before IPVD under 23 G (gauge)-vitrectomy system. The PPH involved the limited extent of IPVD and limited removal of the outermost vitreous cortex to an area slightly beyond the margin of the temporal major vascular arcade. The incidence of retinal breaks related to the surgery was compared with 57 eyes that had undergone conventional 23-G total vitrectomy accompanied by extensive IPVD using χ²-test.

Results

Patients were followed-up for a mean of 14.3 months (6–30 months) after the surgery. The incidence of peripheral retinal breaks after the PPH was 3.4% (2/59 eyes), which was significantly lower than that in the eyes that underwent conventional 23 G vitrectomy (15.8%, 9/57 eyes, P=0.023) for the same disorders that required an IPVD. No patient complained of postoperative floaters, postoperatively.

Conclusions

PPH would be an efficient procedure to prevent iatrogenic peripheral retinal breaks related to an IPVD.     

Safety and efficacy of simultaneous bilateral 25-gauge lens-sparing vitrectomy for vascularly active stage 4 retinopathy of prematurity

Purpose

To report the safety and efficacy of simultaneous bilateral 25-gauge lens-sparing vitrectomy for vascularly active stage 4 retinopathy of prematurity (ROP).

Methods

Retrospective, noncomparative, consecutive case series. Twenty eyes of 10 babies who presented with vascularly active stage 4 ROP in both the eyes underwent simultaneous bilateral 25-gauge lens-sparing vitrectomy. After completing surgery for one eye, the other eye was re-prepped as performed before starting any new case of a different patient and an entire new set of disposable 25-gauge instruments were used. During the post-operative period parents were advised to keep separate eye drops for each eye and to wash their hands in between switching the eyes to put the drops.

Results

The mean follow-up was 8.7 months (range 4–17 months). None of the cases developed any signs of infection. The anatomic success rate for stage 4a was 100% (11/11 eyes) and for stage 4b was 8/9 eyes (89%).

Conclusion

These results show that simultaneous bilateral 25-gauge lens-sparing vitrectomy for stage 4 ROP is a safe and effective procedure with a good outcome provided both eyes of the baby are treated as eyes of two different patients.     

Bevacizumab prior to vitrectomy for diabetic traction retinal detachment

Purpose

To assess the efficacy and safety of preoperative intravitreal bevacizumab (IVB) before vitrectomy for diabetic tractional retinal detachment (TRD).

Methods

Using ICD-9 codes, we located all patients with diabetic TRD who underwent 3-port 20-gauge vitrectomy primarily performed by one surgeon between January 2004 and January 2009. Eyes receiving IVB were compared with those not. The following outcomes were compared: visual acuity (VA), duration of surgery, and complication rates.

Results

A total of 99 eyes of 90 patients were included in the analysis. In all, 34 patients received IVB on an average of 11.5 (range, 3–30) days previtrectomy. Age was 46.5 and 51.6 in the IVB and non-IVB groups, respectively. VA was improved significantly in both groups: from 20/617 to 20/62 in the IVB group, and from 20/443 to 20/86 in the non-IVB group (P=0.11 between groups). Operating time and postoperative complications (glaucoma, RD, and revitrectomy rate) were similar in both groups. On comparing IVB and non-IVB eyes in younger patients (≤40), operating time was shorter (P=0.02) and a trend to better VA in the IVB group was seen.

Conclusions

Preoperative IVB may be a useful adjunct to vitrectomy for severe PDR complicated by TRD, particularly in younger diabetics.     

Intraoperative iatrogenic peripheral retinal break in 23-gauge transconjunctival sutureless vitrectomy versus 20-gauge conventional vitrectomy

Background

To compare the incidence of intraoperative iatrogenic peripheral retinal breaks (IPRBs) during 23-gauge transconjunctival sutureless vitrectomy (TSV) and conventional 20-gauge vitrectomy for various indications.

Methods

This was a single-center, comparative, retrospective, interventional case series of 973 23-gauge TSVs and 402 conventional 20-gauge vitrectomies done by two surgeons between January 2004 and December 2009. The incidence rate of intraoperative IPRBs and risk factors were analyzed in association with various clinical and surgical factors.

Results

IPRBs occurred significantly less often during 23-gauge TSV (16 of 973 cases, 1.6 %) than during conventional vitrectomy (25 of 402 cases, 6.2 %, P?<?0.001). Univariate analysis revealed that conventional vitrectomy and operation time were risk factors for the complication. Multivariate logistic regression analysis also revealed that conventional vitrectomy (P?=?0.03, OR?=?2.91), operation time (P?<?0.01, OR?=?1.01), and intraoperative induction of posterior vitreous detachment (PVD, P?=?0.04, OR?=?1.97) were risk factors for IPRBs.

Conclusions

The 23-gauge TSV procedure with the trocar system has a lower incidence of intraoperative IPRBs than conventional 20-gauge vitrectomy. Longer operation time and induction of PVD are also independent risk factors of the complication.     

Pilot randomised controlled trial of face-down posturing following phacovitrectomy for macular hole

Background

To gather information on the effect of postoperative face-down posturing following combined phacoemulsification and vitrectomy for macular hole surgery in order to assist in the design of a larger definitive study.

Methods

Thirty phakic patients with stage II–IV full-thickness macular hole had combined phacoemulsification and pars plana vitrectomy with internal limiting membrane peel and 14% perfluoropropane (C₃F₈) gas. At the conclusion of surgery, patients were randomised either to face-down posture or to no posture, for 10 days. The primary outcome was macular hole closure.

Results

The macular hole was successfully closed in 93.8% of the face-down posture group and in all of the no-posture group. Mean visual improvement was 0.63 (SD=0.21) logMAR units in the face-down group and 0.53 (SD=0.22) in the no posture patients.

Conclusion

Following combined phacoemulsification and vitrectomy, postoperative face-down posturing appears to make little difference to the final anatomical or visual outcome. If we assume a success rate of 95% in the posturing arm, and that there is no difference between posturing and non-posturing, then 798 patients would be required to be 90% sure that the 95% confidence interval will exclude a difference of more than 5%.     

Is day-1 postoperative review necessary after pars plana vitrectomy?

Purpose

This study aimed to determine the proportion of patients requiring alteration in management based on the findings of the day-1 postoperative visit after pars plana vitrectomy, and to identify clinical characteristics that predict the need for unexpected intervention.

Patients and methods

A retrospective case note review was conducted of all patients who underwent pars plana vitrectomy and who then attended for review on the first postoperative day. All patients received routine prophylactic anti-glaucoma medication.

Results

Two hundred and seventy-three patients examined on day 1 following vitrectomy were studied. Indications for surgery included retinal detachment, epiretinal membrane, macular hole, vitreous haemorrhage, diabetic eye disease, and floaters. Twenty-gauge (20G) vitrectomy was performed in 124 eyes (45%); 23-gauge (23G) vitrectomy was performed in 149 eyes (55%). Phacoemulsification was performed concurrently in 51/273 (19%) eyes. Ten patients (3.7%) required unexpected intervention on day 1 owing to intraocular pressure (IOP) >30 (2/273), IOP <6 (5/273), or unexpected return to theatre for anterior chamber washout (3/273). There was no difference in intervention rate or day-1 IOP between 20G and 23G cases. Hypotony was less common if gas tamponade was used (χ²-test, P<0.001). Patients undergoing combined phacoemulsification and 20G vitrectomy were significantly more likely to require intervention on day 1 than patients undergoing 20G vitrectomy alone (15.0 vs 1.9%, P=0.029, Fisher''s exact test) but this was not the case for patients undergoing 23G vitrectomy (0 vs 4.2%, Fisher''s exact test, P=0.58).

Conclusions

The intervention rate on the first day after vitrectomy is low and day-1 postoperative review can be safely omitted in the majority of patients undergoing vitrectomy.