Outcomes of 23- and 25-gauge transconjunctival sutureless vitrectomies for idiopathic macular holes

Kusuhara, Sentaro; Ooto, Sotaro; Kimura, Daisaku; Itoi, Kazumi; Mukuno, Hirokazu; Miyamoto, Noriko; Akimoto, Masayuki; Kuriyama, Sei; Takagi, Hitoshi

doi:10.1136/bjo.2008.140533

Cited by 51 publications

(39 citation statements)

References 19 publications

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“…The anatomical closure rates compare very favourably with those of other published series looking at PVT and intravitreal gas tamponade with closure rates of 89-100% 5, 12-14 and vitrectomy alone with intravitreal gas tamponade demonstrating a closure rate of 96%. 14,15 The incidence of inducing iatrogenic retinal breaks in 20-gauge vitrectomy for macular hole (without ILM peeling) has been reported as 3.2% with a hole closure 15,18 Macular hole surgery is associated with a higher incidence of causing iatrogenic retinal breaks than vitrectomy surgery for other vitreoretinal pathology, 19,20 presumed to be due to the surgical induction of a posterior vitreous detachment. Induction of the posterior vitreous detachment can cause a tractional retinal break usually near the vitreous base inferiorly.…”

Section: Discussionmentioning

confidence: 99%

20-gauge and 23-gauge phacovitrectomy for idiopathic macular holes: comparison of complications and long-term outcomes

Krishnan

Tossounis

Yang

2012

Eye

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Purpose To assess and compare the complications and long-term visual and anatomical outcomes of 20-and 23-gauge phacovitrectomy (PVT) for idiopathic macular hole repair. Methods A retrospective, consecutive, interventional case series of 72 eyes with idiopathic macular holes were managed with 20-gauge PVT (n ¼ 36) or 23-gauge PVT (n ¼ 36). All patients underwent a posteriorchamber intra-ocular lens implantation and internal-limiting-membrane peel with the aid of either trypan blue or brilliant blue G 250 dyes. Results The macular hole closure rate was 97% with 20-gauge PVT and 100% with 23-gauge PVT. Mean follow-up was 24.06 ( ± 12.83) months with 20-gauge PVT and 17.47 ( ± 5.79) with 23-gauge PVT. Mean visual acuity improvement in LogMar was 0.41 ( ± 0.32) with 20-gauge PVT and 0.52 (±0.25) with 23-gauge PVT (P ¼ 0.135). The incidence of retinal breaks was higher with the 20-gauge PVT compared with the 23-gauge PVT, occurring in 13 (36.1%) and 4 (11.1%) cases, respectively (P ¼ 0.025). There were no cases of retinal detachment. Postoperative intraocular pressure (IOP), at day 1, was significantly higher with 20-gauge PVT at 24.77 (±12.68) mm Hg compared with 17.20 (±6.95) mm Hg in 23-gauge PVT (P ¼ 0.0028). Operating times were longer in 20-gauge PVT at 89.36 ( ± 15.26) min compared with the 23-gauge PVT at 79.33 ( ± 23.82) min (P ¼ 0.04). Conclusion The 20-gauge PVT compared with 23-gauge PVT for macular hole repair is a slightly longer procedure and was associated with an increased incidence of retinal breaks and short-term elevated IOP. Both techniques have comparable visual and anatomical outcomes, but the 23-gauge PVT has advantages with regard to safety profile and operating time.

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Section: Discussionmentioning

confidence: 99%

20-gauge and 23-gauge phacovitrectomy for idiopathic macular holes: comparison of complications and long-term outcomes

Krishnan

Tossounis

Yang

2012

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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“…‹diyopa-tik makula deli¤i tedavisinde 23-G ve 25-G TSV uygulanan hastalar›n karfl›laflt›r›ld›¤› bir çal›flmada 25-G grubunda makula deli¤i kapanma oran› %92 olarak bildirilmifltir. Ayn› çal›flmada 25-G grubunda görme keskinli¤i 20/80'den 20/34'e yükselmifltir (17). Bizim çal›flmam›zda da benzer flekilde anatomik baflar› %92,3 olarak saptanm›flt›r.…”

Section: Tart›flmaunclassified

“…Makula deli¤i cerrahisinde anatomik baflar› oran› 20-G PPV sonras› %87,2-100, 23-G TSV sonras› %80-96 oldu¤u çeflitli yay›nlarda bildirilmifltir (17)(18)(19)(20). Makula deli¤i cerrahisinde 20-G ve 23-G PPV ile bildirilmifl olan bu anatomik baflar› oranlar› çal›flmam›zla ve di¤er 25-G TSV çal›flmala-r›yla benzerlik göstermektedir (15)(16)(17).…”

Section: Tart›flmaunclassified

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25-Gauge Transconjunctival Sutureless Vitrectomy for Idiopathic Macular Hole

Yanyalı¹,

Dinçyildiz²,

Çelik³

et al. 2010

tod

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Outcomes of 23- and 25-gauge transconjunctival sutureless vitrectomies for idiopathic macular holes

Abstract: 23-gauge TSV appears to be as safe and effective as 25-gauge TSV in macular hole surgery.

Cited by 51 publications

References 19 publications

20-gauge and 23-gauge phacovitrectomy for idiopathic macular holes: comparison of complications and long-term outcomes

20-gauge and 23-gauge phacovitrectomy for idiopathic macular holes: comparison of complications and long-term outcomes

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

25-Gauge Transconjunctival Sutureless Vitrectomy for Idiopathic Macular Hole

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