25-, 23-, and 20-gauge vitrectomy in epiretinal membrane surgery: a comparative study of 553 cases

Sandali, Otman; Sanharawi, Mohamed El; Lecuen, Nicolas; Barale, Pierre-Olivier; Bonnel, S.; Basli, Elena; Borderie, Vincent; Laroche, L.; Monin, C

doi:10.1007/s00417-011-1752-3

Cited by 81 publications

(61 citation statements)

References 37 publications

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“…The issue of compromised wound integrity due to the lack of sutures possibly leading to complications such as hypotony, endophthalmitis and choroidal hemorrhage has been a matter of discussion [1]. However, one other important difference between the sutureless and the conventional techniques are the microcannula-guided entry sites into the eye [2,3,4,5,6,7]. Even though vitreous incarceration to the microcannulas has been documented, the microcannula system has been proposed to lower the risk of retinal dragging (with formation of iatrogenic retinal defects) during vitrectomy [3,4,5,7].…”

Section: Introductionmentioning

confidence: 99%

Intraoperative Retinal Break Formation in 23-/25-Gauge Vitrectomy versus 20-Gauge Vitrectomy

2012

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Background: This study was undertaken to examine the possible effect of microcannula-guided entry sites on the rate of intraoperative retinal break formation. Methods: In this historical cohort study, all patients having undergone vitrectomy with epiretinal or internal limiting membrane peeling performed by one surgeon between January 2005 and March 2009 were included. All procedures with microcannula-guided entry sites (23- and 25-gauge vitrectomy) were compared to procedures without the use of microcannulas (20-gauge vitrectomy). Results: A total of 221 eyes with a follow-up of at least 30 days were analyzed. The total incidence of intraoperative retinal break formation was 25.2% (n = 28/111) for the 20-gauge group and 12.7% (n = 14/110) for the 23-/25-gauge group, resulting in an odds ratio of 2.313 (95% confidence interval 1.142–4.685) of an increased rate in the 20-gauge group. Conclusion: This study demonstrates that intraoperative retinal breaks during vitrectomy are reduced in the microcannula-guided techniques compared to 20-gauge vitrectomy. This effect may be attributed to the protection of the vitreous base during surgery. Further prospective studies are warranted.

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Section: Introductionmentioning

confidence: 99%

Intraoperative Retinal Break Formation in 23-/25-Gauge Vitrectomy versus 20-Gauge Vitrectomy

2012

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“…The longer duration of vitreous extraction through the smaller-caliber instrument is obviously more than outweighed by technical simplification with a net shortening of procedural time by about 10%. 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.…”

Section: Discussionmentioning

confidence: 91%

“…6,11,12,23 All in all, single-session 23-gauge ppv with b-MICS yields excellent results equivalent to those of conventional twostep procedures in the treatment of macular hole with cataract.…”

Section: Discussionmentioning

confidence: 92%

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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“…1,3,6,12,13 On the other hand, an IPVD is thought to be an important etiology when the breaks are located in the inferior quadrants. 2,3,5 Two of three (66.7%) retinal breaks in the PPH group were identified in the superior quadrants, near the sclerotomy sites, suggesting the etiology of these breaks could be sclerotomy-related rather than IPVD-related.…”

Section: Discussionmentioning

confidence: 98%

“…1,[3][4][5] However, a fundamental strategy to prevent the development of iatrogenic retinal breaks related to an IPVD has not yet been established. Some investigators have recommended a careful intraoperative and postoperative peripheral examination at the end of each vitrectomy.…”

Section: Introductionmentioning

confidence: 99%

Partial posterior hyaloidectomy for macular disorders

Kim

Kang

Kim

et al. 2013

Eye

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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 w 2 -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 ¼ 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.

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25-, 23-, and 20-gauge vitrectomy in epiretinal membrane surgery: a comparative study of 553 cases

Cited by 81 publications

References 37 publications

Intraoperative Retinal Break Formation in 23-/25-Gauge Vitrectomy versus 20-Gauge Vitrectomy

Intraoperative Retinal Break Formation in 23-/25-Gauge Vitrectomy versus 20-Gauge Vitrectomy

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

Partial posterior hyaloidectomy for macular disorders

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