Perioperative changes of the intraocular pressure during the treatment of epiretinal membrane by using 25- or 27-gauge sutureless vitrectomy without gas tamponade

Abstract

PurposeThe purpose of this study was to compare perioperative intraocular pressures (IOPs) in 25- or 27-gauge microincision vitrectomy surgery (MIVS) and to evaluate the stability of postoperative sclerotomy closure.Materials and methodsThis is a retrospective review of 147 eyes treated for epiretinal membrane by using 25- or 27-gauge MIVS as the initial vitrectomy (25-gauge phacovitrectomy [25-P group]: 73 eyes, 25-gauge vitrectomy alone [25-A group]: 15 eyes, 27-gauge phacovitrectomy [27-P group]: 47 eyes, and 27-gauge vitrectomy alone [27-A group]: 12 eyes). Statistical analyses of perioperative IOPs on preoperative day (PreOp), postoperative day (POD)1, POD2, postoperative week 1, and postoperative month 1 were performed.ResultsAll self-sealing sclerotomies were obtained without gas tamponade at the end of surgery. Also, no significant differences were noted in the age and axial length among the 4 groups and in the surgical time between 25-P and 27-P groups and between 25-A and 27-A groups. Significant decreases in IOP were found at POD1 and POD2 in the 25-P, 25-A, and 27-P groups compared with PreOP, but not in the 27-A group.ConclusionEven though surgeons confirm that there is no leakage from sutureless sclerotomy and that a normal IOP is preserved at the end of 25- or 27-gauge MIVS, there is a possibility of postoperative sclerotomy leakage on the day of the surgery. Furthermore, postoperative sclerotomy self-sealing of the MIVS in previous intraocular lens implantation cases is considered to be acquired easily than that in phacovitrectomy.

Comparison of 27-gauge versus 25-gauge vitrectomy results in patients with epiretinal membrane: 6-month follow-up

“…In consequence, shorter scleral tunnel could be created with higher possibility of wound leakage and prolonged healing. It is difficult to compare our result with the ones obtained by Naruse et al [8] and Nakashina et al [10] because of different angle of trocar placement, use of air or gas exchange, phacovitrectomy performance and more than one operating surgeon involved.…”

“…The use of 27G PPV in the treatment for posterior segment diseases [4][5][6] becomes more and more common, including the surgical treatment of some macular diseases, such as epiretinal membranes. There are no conclusive study results in the literature available that would indicate superiority of 27G vitrectomy over 25G vitrectomy in the treatment for epiretinal membranes [7][8][9][10]. That is why we decided to conduct this prospective study on 60 eyes with idiopathic epiretinal membranes undergoing 27G or 25G vitrectomy and compare postoperative outcomes.…”

Comparison of 27-Gauge and 25-Gauge Microincision Vitrectomy Surgery for the Treatment of Vitreoretinal Disease: A Systematic Review and Meta-Analysis

“…In order to explore the potential sources of heterogeneity, sensitivity analysis (via excluding the studies one by one) was proceeded. After the Takashina et al study [17] was excluded, the heterogeneity almost disappeared (I 2 � 19%, P � 0.27; MD � 3.64; 95% CI: 2.29, 4.99; P < 0.001), which indicated this study can be identified as the main contributor of heterogeneity. We reevaluated the study of Takashina et al in terms of design, statistics, and selection bias and did not find anything wrong.…”

“…Seven studies [ 15 , 21 – 24 , 26 , 31 ] were designed as prospective randomized/nonrandomized comparative study and four studies [ 17 , 25 , 29 , 30 ] were retrospective randomized/nonrandomized comparative study. Five trials [ 15 , 17 , 21 , 24 , 29 ] enrolled 554 eyes which were conducted on ERM and six studies [ 22 , 23 , 25 , 26 , 30 , 31 ] enrolled 386 eyes which were conducted on RRD. In total, 940 eyes were included in this meta-analysis; 439 eyes were assigned to the 27-G vitrectomy group and 501 eyes to the 25-G group.…”

“…In 2010s, Oshima et al first described 27-G MIVS for the treatment of vitreoretinal diseases [14]. In the beginning, the 27-G vitrectomy was conducted mainly for simple cases such as epiretinal membrane (ERM), idiopathic macular holes, and vitreous hemorrhage [15][16][17]; recently, indications for 27-G vitrectomy have since been expanded to more complicated conditions, including proliferative diabetic retinopathy, rhegmatogenous retinal detachment (RRD), and proliferative vitreoretinopathy [18][19][20]. Many studies have shown the advantages of 27-G MIVS in terms of patients' comfort, convalescence, inflammatory response, and visual recovery in the ERM surgery compared with traditional 25-G vitrectomy [15,17,[21][22][23].…”