Combined 25- and 23-gauge surgery: a new sutureless vitrectomy technique.

The 25- and 23-gauge sutureless vitrectomy techniques decrease the surgical trauma and improve patients' postoperative comfort. The disadvantages of the 25-gauge system include pliable instrument and slower gel removal. The 23-gauge system provides faster speed of vitrectomy and the instruments have stiffer shafts, but it requires a larger incision. To circumvent some of these limitations, a new sutureless transconjunctival vitrectomy technique that combines 23- and 25-gauge cannulas and instruments was studied. Fifty-three patients underwent vitreoretinal surgery using two 25-gauge ports for the infusion and light probe and one 23-gauge port for the vitreous cutter and various instruments. No intraoperative or postoperative complications were noted and no cases required conversion to another technique.     

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.     

Pars plana vitrectomy for disturbing primary vitreous floaters: clinical outcome and patient satisfaction

Background

Primary vitreous floaters can be highly bothersome in some patients. In the case of persistently bothersome floaters, pars plana vitrectomy may be the most effective treatment. The aim of this study is to evaluate the incidence of complications, and patient satisfaction, after pars plana vitrectomy for disabling primary vitreous opacities.

Methods

We included a total of 110 eyes that underwent pars plana vitrectomy between February 1998 and August 2010. Fifty-seven eyes (51.8 %) underwent 20-gauge vitrectomy, whereas 53 eyes (48.2 %) underwent 23-gauge vitrectomy. In a retrospective manner, we assessed intraoperative and postoperative complications. There was a considerable range of time between surgery and questionnaire (range: 4–136 months). Patient satisfaction was assessed by a questionnaire based on a modified NEI VFQ-25 questionnaire.

Results

A retinal detachment occurred in 10.9 % of cases, and the incidence did not differ significantly between the 20-gauge and 23-gauge vitrectomy groups. In 4.5 % of the eyes, a retinal detachment developed within the first 3 months, and 6.4 % occurred later in the postoperative period. Cystoid macular edema occurred in 5.5 %, and an epiretinal membrane was seen postoperatively in 3.6 % of cases. Development of glaucoma requiring glaucoma surgery, a macular hole, and postoperative scotoma, each occurred in 0.9 % of cases. No cases of endophthalmitis occurred. Eighty-five percent of patients were satisfied or very satisfied with the results of the vitrectomy. Eighty-four percent of all patients were completely cured from their troublesome vitreous floaters, and an additional 9.3 % of patients were less troubled by vitreous floaters. Ten patients (9.3 %) were dissatisfied, and six of these patients (5.6 %) had a serious complication that resulted in permanent visual loss.

Conclusions

Pars plana vitrectomy is an effective approach to treat primary vitreous floaters, resulting in a high rate of patient satisfaction. Postoperative complications may be more frequent than previously reported, so patients should be well-informed about the complication rate before reaching informed consent about this surgical intervention. Additional preventive measures should be considered to reduce this complication rate.     

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.     

27G微创玻璃体切除手术的发展及应用

自二十世纪初25 G、23 G无缝线玻璃体切除术的相继推出,已将我们带入玻璃体视网膜手术的微创时代约有10余年历史。与传统20 G三通道玻璃体切除术相比,25 G、23 G无缝线微创玻璃体切除术不仅缩小巩膜切口,而且还大大简化了手术程序,缩短了手术时间及降低了手术并发症。因此,在过去十余年时间里,越来越多的医生由传统的20 G玻璃体切除术转向25 G、23 G玻璃体切除术。但随着微创玻璃体切除术的普及,无缝线巩膜切口的相关并发症也随之增多。本着“越小越好”的理念,眼科学者开始研究下一代玻切手术,并且得益于不断更新换代的高速玻切机、高通量的照明光源、更精细的制造技术和清晰广角镜的发展,日本学者Oshima于2010年正式推出了27G玻璃体切除术。27 G玻璃体切除术较之前的微创玻璃体切除术切口更小,切割速率更高,带给眼底外科医生全新的体验。目前27 G甚至更细的玻璃体切除术尚处在继续革新之中,围绕其优缺点、适应证及未来发展也逐渐成为大家关注讨论的焦点。本文在此结合笔者27 G玻璃体切除术经验,对27 G微创玻璃体切除术玻璃体切除术进行了一个简要的综述。     

The efficacy of retrobulbar block anesthesia only in pars plana vitrectomy and transconjunctival sutureless vitrectomy.

BACKGROUND AND OBJECTIVE: To evaluate the adequacy of retrobulbar block anesthesia only in vitreoretinal surgery. PATIENTS AND METHODS: The study involved 90 patients, 25 who underwent 25-gauge transconjunctival sutureless vitrectomy and 65 who underwent 20-gauge standard pars plana vitrectomy. Twenty-five of the 90 patients also underwent combined phacoemulsification and posterior intraocular lens implantation. The efficacy of retrobulbar block anesthesia only was assessed by monitoring vital signs during surgery, reviewing patient responses to a questionnaire regarding their experience during surgery, and analyzing surgical outcomes. RESULTS: Four patients complained of moderate pain during surgery, but no patient complained of severe pain. Infiltrative anesthesia was additionally required in 14 patients. No patient experienced intraoperative complications due to head movement. Increased systolic blood pressure greater than 15 mm Hg occurred in 11 patients and increased respiratory rate by 3 breaths per minute or greater occurred in 7 patients. Anatomical and functional success rates were 95% and 80%, respectively. Complications included manageable retrobulbar bleeding (1 patient) and postoperative neovascular glaucoma (2 patients). CONCLUSION: Vitreoretinal surgery, particularly 25-gauge transconjunctival sutureless vitrectomy, can be safely and efficiently performed under retrobulbar block anesthesia only. Retrobulbar block anesthesia only could become a more acceptable anesthesia for vitreoretinal surgery for selected patients.     

Surgically induced astigmatism in combined phacoemulsification and vitrectomy; 23-gauge transconjunctival sutureless vitrectomy versus 20-gauge standard vitrectomy

Background

To study the surgically induced astigmatism (SIA) in combined phacoemulsification with 23-gauge transconjunctival sutureless vitrectomy (TSV) versus combined phacoemulsification with 20-gauge standard vitrectomy.

Methods

This is a prospective comparative study comprised of 40 eyes from 37 consecutive patients. Twenty eyes (19 patients) underwent combined phacoemulsification and 23-gauge TSV, and 20 eyes (18 patients) underwent combined phacoemulsification and 20-gauge standard vitrectomy. Corneal topography was obtained preoperatively and postoperatively at weeks 1, 4, 8, and 12. Main outcome measurement was SIA consisting of astigmatic amplitude and axis from cross cylinder form calculated by rectangular coordinate method using the Holladay-Cravy-Koch formula.

Results

The mean SIA was 1.07?±?0.57 diopters (D) in the 23-gauge TSV group and 2.09?±?0.81 D in the 20-gauge group at postoperative week 1. SIA of both groups at weeks 4, 8, and 12 significantly decreased from the SIA at postoperative week 1 (p?<?0.0001 for all 3 weeks). SIA of the 23-gauge TSV group was significantly less than that of the 20-gauge standard vitrectomy group at each postoperative period (p?=?0.001). SIA of the gas tamponade group in the 23-gauge TSV was significantly greater than that of the non-gas tamponade group at postoperative week one (p?=?0.039). Shifts of axis to other meridians returned to preoperative meridian in 12 eyes (85.7%) for the 23-gauge group and seven eyes (43.8%) for the 20-gauge group.

Conclusion

Combined phacoemulsification and pars plana vitrectomy (23-gauge and 20-gauge) could induce significant SIA at postoperative week 1, and decrease over 3 months. However, 23-gauge TSV showed less SIA and early stabilization compared to the 20-gauge standard vitrectomy.     

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.     

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.     

Clinical outcomes of 25-gauge vitrectomy surgery for vitreoretinal diseases: comparison of vitrectomy alone and phaco-vitrectomy

AIM: To compare the clinical outcomes of combined 25-gauge pars plana vitrectomy (PPV) and phacoemulsification/posterior chamber intraocular lens (PC-IOL) implantation with vitrectomy alone surgery in patients with various vitreoretinal diseases. METHODS: A total of 306 eyes (145 with PPV alone and 161 with phaco-vitrectomy) were enrolled in this retrospective analysis. The surgical approach was 25-gauge PPV combined with phacoemulsification and PC-IOL implantation at the same time in eyes in phaco-vitrectomy group and only PPV in eyes in vitrectomy alone surgery group. The main outcome measures were postoperative clinical outcomes included anterior chamber inflammation, changes in intraocular pressure (IOP) and best corrected visual acuity (BCVA). RESULTS: The most common postoperative complication was anterior chamber reaction which has higher incidence in phaco-vitrectomy group (P<0.001). The mean postoperative 1st day IOP of vitrectomy alone group was significantly lower than that of phaco-vitrectomy group (16.3±5.8 mm Hg vs 17.8±8.1 mm Hg, respectively, P=0.02). Hypotony (IOP(8 mm Hg) was not different between groups in the postoperative 1st day (P>0.05). The mean preoperative visual acuity was not different between groups (1.6±0.9 logMAR vs 1.8±0.9 logMAR, respectively, P>0.05). However, the mean visual acuity was decreased in vitrectomy alone group at the final visit compared to phaco-vitrectomy group (1.2±0.8 logMAR, 0.9±0.7 logMAR, respectively P<0.05). CONCLUSION: Twenty-five gauge PPV combined with phacoemulsification surgery is a safe and efficient procedure, which can be preferred in phacic patients with a variety of vitreoretinal diseases compared to vitrectomy alone. Despite improved outcomes, this approach is not free of limitations as anterior chamber complications especially with combined surgery.     

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.     

23G微创玻璃体切割术治疗特发性黄斑裂孔的疗效

目的：观察23G 微创玻璃体切割术治疗特发性黄斑裂孔的临床效果。方法：选取2013-01/10在我院采用23G 玻璃体切割系统治疗特发性黄斑裂孔患者28例28眼,进行回顾性研究。对患者进行 3～12mo的术后随访观察,进行疗效评价与分析。结果：23G微创玻璃体切割术治疗特发性黄斑裂孔28 眼,27眼黄斑裂孔愈合,1眼未愈合。术后1,3mo矫正视力较术前有显著提高（χ2=8.65,P=0.003; χ2=10.33,P=0.001）。光学相干断层扫描（optical coherence tomography,OCT）提示黄斑区裂孔封闭。术中切口缝合5例（18%）。术后眼压与术前相比差异无统计学意义。术后未发生眼内炎、视网膜脱离、玻璃体出血等并发症。结论：23G微创玻璃体切割术是治疗特发性黄斑裂孔的一种安全有效的方法,对于简单的黄斑区手术考虑首选23G微创玻璃体切割术。     

Rotational stability of plate haptic toric intraocular lenses after combined 25-gauge vitrectomy and cataract surgery

AIM: To evaluate the postoperative intraocular lens (IOL) rotational stability and residual refractive astigmatism following combined 25-gauge vitrectomy and cataract surgery with implantation of a plate haptic toric IOL. METHODS: In this retrospective case series, 32 eyes of 32 patients underwent a combined 25-gauge vitrectomy and phacoemulsification for vitreoretinal diseases and cataract with regular corneal astigmatism of at least 1 diopter (D). A plate haptic toric IOL (AT Torbi 709M, Carl Zeiss Meditec AG) was implanted in all eyes. The outcome measures were rotational stability and refractive astigmatism up to 6mo postoperatively as well as the best corrected visual acuity (BCVA). RESULTS: Preoperative refractive astigmatism was 2.14±1.17 D, which was significantly reduced to 0.77±0.37 D six to eight weeks postoperatively and remained stable throughout the observation period (0.67±0.44 D at three months and 0.75±0.25 D at six months; for all groups: P<0.0001 compared to baseline). BCVA improved significantly from 0.36±0.33 logMAR preoperatively to 0.10±0.15 logMAR following surgery (P=0.02). Mean IOL axis deviation from the target axis was 3.4°±2.9° after six to eight weeks and significantly decreased over time (2.4°±2.6° six months after surgery; P=0.04). In one patient IOL, re-alignment was performed. CONCLUSION: Corneal astigmatism is significantly reduced following combined 25-gauge vitrectomy and cataract surgery. The plate haptic toric IOL position and axis remain stable during the observation period of six months.     

Transconjunctival sutureless vitrectomy versus 20-gauge vitrectomy for vitreoretinal surgery: a meta-analysis of randomized controlled trials

Background

Transconjunctival sutureless vitrectomy is appealing to vitreoretinal surgeons around the world. However, its use versus 20-gauge vitreoretinal surgery is still controversial. The aim of this meta-analysis was to compare the safety and functional outcomes of transconjunctival sutureless vitrectomy versus 20-gauge vitrectomy for vitreoretinal surgery.

Methods

Data sources, including PubMed, Medline, EMBASE, and Cochrane Controlled Trials Register, were searched to identify potentially relevant randomized controlled trials. A meta-analysis was performed using RevMan 5.0 software. The primary factors included patients’ discomfort, operating time and early postoperative complications. Visual acuity and surgically induced astigmatism were chosen as secondary outcomes.

Results

A total of 471 participants with 479 eyes in eight trials between 2005 and 2011 were analyzed. Transconjunctival sutureless vitrectomy was associated with significantly fewer patients suffering from postoperative discomfort at 1 day (odds ratio [OR] 0.07; 95 % confidence interval [CI] 0.01 to 0.49; p?=?0.007) and 7 days (OR 0.14; 95 % CI 0.03 to 0.73; p?=?0.02) follow-up, and was more effective in reducing surgically induced astigmatism (mean difference ?0.23D; 95 % CI ?0.31 to ?0.15; p?<?0.00001) compared to 20-gauge vitrectomy. The sutureless group achieved shorter wound opening (mean difference ?1.97 minutes; 95 % CI ?2.69 to ?1.25; p?<?0.00001) as well as wound closure time (mean difference ?4.55 minutes; 95 % CI ?5.43 to ?3.66; p?<?0.00001), but the overall surgery time was comparable (mean difference ?0.14 minutes; 95 % CI ?3.52 to 3.24; p?=?0.93). There were no significant differences in the complication rates between the two groups with the exception of postoperative hypotony, which was more likely with the sutureless group (OR 3.73; 95 % CI 1.43 to 9.76; p?=?0.007).

Conclusions

According to the present data, transconjunctival sutureless vitrectomy offered significantly less postoperative discomfort and decreased surgically induced astigmatism without increasing the risk of vision-threatening complications. Further trials with contemporary equipment and larger sample size are suggested to confirm this conclusion.     

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.     

Outcomes of 23- and 25-gauge transconjunctival sutureless vitrectomies for dislocated intraocular lenses

Purpose

To compare the outcome of 23-gauge as compared with 25-gauge transconjunctival sutureless vitrectomy (TSV) in the management of dislocated intraocular lenses (IOLs).

Design

Retrospective, non-consecutive, comparative, interventional case series.

Participants

Patients with dislocated intraocular lens who underwent sutureless PPV using either 23-gauge or 25-gauge instruments.

Methods

The patients who presented with a dislocated IOL, underwent TSV with repositioning of the intraocular lens, either in the sulcus or scleral-fixated sutured/glued.

Results

Of the total 61 eyes, 33 (54.09%) underwent 23-gauge TSV and 28 (45.90%) underwent 25-gauge TSV. The mean logMAR BCVA at baseline and 6 months after surgery was 0.8 and 0.46 in the 23-gauge group, and 0.82 and 0.47 in the 25-gauge group. There was no significant difference in logMAR BCVA values between the two groups at any time point of time during the follow-up. The mean postoperative IOP on postoperative day 1 was 14.76 ± 5.4 in 23-gauge group and 17.57 ± 7.9 in the 25-gauge group (p = 0.10). Retinal break was noticed intraoperatively in two cases in 23-gauge group and in three cases in 25-gauge group (p = 0.509). Postoperative complications included IOL decentration in one case of 23-gauge vitrectomy and two cases in 25-gauge group (p = 0.5), cystoid macular edema in four patients in 23-gauge group and six cases of 25-gauge group (p = 0.3) and retinal detachment in one case in each group (p = 0.9).

Conclusions

25-gauge appears to be as safe and as effective as 23-gauge TSV in the management of dislocated intraocular lenses.

     

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.     

眼内填充洁净空气的玻璃体切除术治疗IV期黄斑裂孔的疗效分析

目的  观察眼内填充洁净空气的玻璃体切除术治疗IV期黄斑裂孔的疗效。设计  回顾性病例系列。研究对象  IV期黄斑裂孔患者10例（10眼）。方法 所有患者行最佳矫正视力（BCVA）、眼压、裂隙灯检查、间接检眼镜、彩色眼底照相、眼部彩色多普勒超声、相干光断层扫描（OCT）检查。行23G经睫状体平坦部三通道微创玻璃体切除术,术中玻璃体填充洁净空气辅助顶压视网膜。术后随访9~107天,平均（28.9±33.4）天。主要指标 BCVA、黄斑裂孔闭合以及手术并发症情况。 结果 末次随访时,10眼中,OCT检查黄斑裂孔完全闭合9眼（90%）;部分闭合1眼（10%）。术后末次随访BCVA手动~0.6,平均BCVA（logMAR视力）1.27±0.84;手术前后视力变化-0.3~0.36,较术前平均提高0.26±0.31（t=2.73,P=0.023）。末次随访视力提高者6眼（60%）,平均提高0.56±0.26（0.28~1.00）;视力下降者1眼（10%）,降低0.3;视力稳定者3眼（30%）。结论  此小样本研究结果表明眼内填充洁净空气的玻璃体切除术治疗IV期黄斑裂孔可获得较好疗效。     

23G、25G联合经结膜免缝合微创玻璃体切割术治疗黄斑前膜

目的探讨23G、25G联合经结膜免缝合微创玻璃体切割术(transconjunctival sutureless vitrectomy,TSV)治疗黄斑前膜疗效。方法收集我院22眼应用23G、25G联合TSV治疗黄斑前膜的手术资料。对手术前后最佳矫正视力、光学相干断层扫描(optical coherence tomography,OCT)检查黄斑前膜进行对比分析。术后随访2～9个月,观察对比手术前后视力和OCT检查的黄斑中心凹厚度。结果所有手术均顺利完成,术后视力均明显提高,末次随访最佳矫正视力好于术前矫正视力,差异有统计学意义(P<0.05),其中术后视力提高0.15～0.2者6眼,提高0.1者12眼,提高0.05～0.1者4眼。末次随访时OCT显示术后黄斑中心凹厚度明显低于术前,差异有统计学意义(P<0.05)。结论 23G、25G联合TSV治疗黄斑前膜安全、有效。