23-gauge versus 20-gauge system for pars plana vitrectomy: a prospective randomised clinical trial

Wimpissinger, Barbara; Kellner, L; Brannath, W; Krepler, K; Stolba, U; Mihalics, C; Binder, Susanne

doi:10.1136/bjo.2008.140509

Cited by 77 publications

(76 citation statements)

References 9 publications

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“…Postoperative BCVA and IOP were measured at 1 day, 1 week, and 1 and 3 months after surgery. As a substitute for a patient survey on the postoperative discomfort, the degrees of postoperative conjunctival and corneal change were qualitatively graded using an earlier reported standardized scale 19,20 with some modifications. Briefly, each category of conjunctival injection, conjunctival oedema, subconjunctival haemorrhage, and corneal oedema were scored by slit-lamp examination as 0 (absent), 0.5 (trace), 1 (mild), 2 (moderate), and 3 (severe).…”

Section: Methodsmentioning

confidence: 99%

Comparison of 25- and 23-gauge sutureless microincision vitrectomy surgery in the treatment of various vitreoretinal diseases

Nam

Chung

Lee

et al. 2009

Eye

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Purpose To compare the effectiveness and safety of 25-and 23-gauge sutureless microincision vitrectomy surgery (MIVS) in the management of various vitreoretinal diseases. Methods Eighty-five consecutive patients undergoing sutureless vitrectomy during January to April 2008 were randomized to either 25-or 23-gauge MIVS. Data collected prospectively included best-corrected visual acuity (BCVA), operation time, postoperative visual recovery, postoperative anterior segment change, and complications. Results The most common indications for MIVS were macular hole, macular pucker, vitreous haemorrhage, and diabetic traction retinal detachment. Mean operation times of the 25-gauge (n ¼ 38) and 23-gauge groups (n ¼ 47) were 33.68 and 34.47 min, respectively (P ¼ 0.942). Mean BCVA improved significantly in both the 25-and 23-gauge groups when measured 3-month postoperatively. There was no between-group difference in either the degree or the rate of postoperative visual recovery. Seven patients in the 23-gauge group, compared with three in the 25-gauge group, required suturing of sclerotomy at the end of the surgery. No patients in either group developed postoperative wound leakage or endophthalmitis. Conclusion Our prospective study suggests that, within the limited indications, both 25-and 23-gauge MIVS are equally effective, with similar safety profiles. Gauge selection thus may be made according to a surgeon's preference and the availability of appropriate instruments.

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Section: Methodsmentioning

confidence: 99%

Comparison of 25- and 23-gauge sutureless microincision vitrectomy surgery in the treatment of various vitreoretinal diseases

Nam

Chung

Lee

et al. 2009

Eye

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“…This difference was not statistically significant (P=.22). Smaller studies [8][9][10]12 demonstrated a statistically nonsignificant trend for fewer intraoperative retinal tears, and others 16,18,20,21 reported no intraoperative breaks in either group. To the best of our knowledge, our study is the first that has found a statistically significant reduction in the rate of intraoperative retinal break formation using transconjunctival cannulated PPV.…”

Section: Commentmentioning

confidence: 99%

Intraoperative Retinal Tear Formation and Postoperative Rhegmatogenous Retinal Detachment in Transconjunctival Cannulated Vitrectomy Systems Compared With the Standard 20-Gauge System

Covert¹

2012

Arch Ophthalmol

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Objective: To compare 20-gauge standard pars plana vitrectomy (PPV) with transconjunctival cannulated PPV in the development of intraoperative retinal breaks and postoperative rhegmatogenous retinal detachments (RRDs) in a large series of patients undergoing PPV for macular pucker or macular hole. tation for pars plana vitrectomy (PPV) for macular pucker and macular hole continue to evolve. The latest advances include small-gauge, transconjunctival, cannulated systems; the first report on these systems was made in 2002 by Fujii and colleagues, 1 who assessed a 25-gauge system. Since that time, 23-gauge systems and 20-gauge transconjunctival cannulated systems have been developed. Potential advantages of transconjunctival cannulated vitrectomy systems include improved fluidics, a more tightly contained system, smoother entry and exit, port positioning closer to the tip for closer shaving, reduced need for sclerotomy suturing, and decreased surgical time. A recent systematic review 2 formalized other potential advantages, including decreased postoperative inflammation, increased postoperative comfort, and reduced time to obtain visual acuity improvement. This report also concluded that transconjunctival cannulated vitrectomy systems demonstrated an acceptable safety profile compared with standard 20-gauge PPV.The aim of this study was to compare standard 20-gauge PPV with transconjunctival cannulated PPV in the development of intraoperative retinal breaks and postoperative rhegmatogenous retinal detachments (RRDs) in a large series of patients undergoing PPV for macular pucker or macular hole at a tertiary care vitreoretinal practice.

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“…Whereas some authors describe a shorter operation time for 23-7,11,12 and 25-gauge ppv, 5,7,12 respectively, others find no difference. 13,14 When comparing operation times, the exact procedure and its respective time requirement must be considered; for instance, a longer duration of the actual vitreous extraction that outweighs the benefit of the non-suture may be a result of a lower cutting rate. Moreover, the additional cataract operation performed in the present series must be accounted for about 10-15 min, putting the operation time in the present series more or less in the same order of magnitude as in most other trials.…”

Section: Discussionmentioning

confidence: 99%

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

2013

Eye

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Background/aims 23-gauge pars plana vitrectomy (ppv) is a new method for vitreoretinal 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 ¼ 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.

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23-gauge versus 20-gauge system for pars plana vitrectomy: a prospective randomised clinical trial

Abstract: The 23-gauge system for pars plana vitrectomy offers significantly higher patient comfort during the early postoperative period. Time of surgery is almost equal--a shorter time for wound closure is neutralised by a longer vitrectomy time in the 23-gauge group.

Cited by 77 publications

References 9 publications

Comparison of 25- and 23-gauge sutureless microincision vitrectomy surgery in the treatment of various vitreoretinal diseases

Comparison of 25- and 23-gauge sutureless microincision vitrectomy surgery in the treatment of various vitreoretinal diseases

Intraoperative Retinal Tear Formation and Postoperative Rhegmatogenous Retinal Detachment in Transconjunctival Cannulated Vitrectomy Systems Compared With the Standard 20-Gauge System

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

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