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

Abstract

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.

Influences of 27-Gauge Vitrectomy on Corneal Topographic Conditions

“…Moreover, vitrectomy itself causes cataracts to progress. Thus, treating cataract and vitreoretinal diseases in a combined one-step microincision phacovitrectomy is an effective and well-tolerated method and is becoming one of the common procedures [ 14 – 16 ]. In our study, 45 of the 56 eyes (80.3%) underwent phacovitrectomy.…”

“…In our study, 45 of the 56 eyes (80.3%) underwent phacovitrectomy. Phacovitrectomy eliminates the need for a second operation, and also offers potential for better surgical outcomes partially due to the improved access to the retinal periphery [ 16 , 17 ]. With regard to influences on corneal topography, there were no significant differences between phacovitrectomy and vitrectomy alone, and thus further supports the usefulness of the combined procedure.…”

Cataract surgery combined with micro-incision vitrectomy in patients with behcet’s disease uveitis

“…However, fear of surgery-associated intraocular inflammation has limited the clinical application of such treatment. Recently, there has been increasing progress in combined surgical techniques for cataract and pars plana vitrectomy surgeries, such as micro-incision cataract surgery combined with 23G or 25G sutureless vitrectomy (micro-incision vitrectomy (MIVS)) [ 2 – 4 ]. Besides, combined surgery has been complicated in eyes with uveitis [ 5 , 6 ].…”

Comparison of 1.8‐mm incision versus 2.75‐mm incision cataract surgery in combined phacoemulsification and 23‐gauge vitrectomy

“…). Combined C‐MICS or B‐MICS and small‐gauge vitrectomy offers the combined advantages of MICS associated with less wound leakage, good anterior chamber (AC) stability and safety together with small‐gauge vitrectomy providing decreased inflammation and faster rehabilitation after surgery (Schonfeld ; Czajka et al. ; Jalil et al.…”