Postoperative retinal break after 25-gauge transconjunctival sutureless vitrectomy: report of four cases

Okuda, Tetsuhiko; Nishimura, Akira; Kobayashi, Akira; Sugiyama, Kazuhisa

doi:10.1007/s00417-006-0354-y

Cited by 26 publications

(18 citation statements)

References 9 publications

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“…Also the vitreous incarceration at 1 sclerotomy did not induce a retinal break or retinal detachment. These data are comparable to Okuda et al [9], who observed retinal breaks in 5.3% of patients, or Ibarra et al [10], who reported retinal detachment in 2.2% of patients after 25-gauge transconjunctival vitrectomy. Sutures with a non-monofilament stitch could be a problem, particularly for infections.…”

Section: Discussionsupporting

confidence: 78%

Transconjunctival 20-Gauge Vitrectomy: A Pilot Study

2008

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Purpose: To determine the efficacy of a novel technique for a ‘transconjunctival 20-gauge vitrectomy’ (T20V). Methods: In total, 12 eyes of 12 consecutive patients were included in a prospective study. The mean age was 58 years (range: 38–74 years); 4 patients were male and 8 were female. The T20V was indicated when short-duration vitrectomy was envisioned: macular surgery for macular hole and epiretinal membrane therapy, moderate vitreous hemorrhage due to retina vein occlusions or diabetic retinopathy, or neurotomy for central retinal vein occlusion. Results: The average time for each procedure was 35 ± 30 min (SD). The preoperative visual acuity ranged from 20/200 to hand motions, while postoperative vision was between 20/30 and counting fingers. The average intraocular pressure changed from 16.1 ± 5.6 mm Hg preoperatively to 15.8 ± 8.1 mm Hg in the first postoperative day, and 17.8 ± 9.4 mm Hg 1 week after surgery – these differences were not statistically significant (p > 0.05). Subjective postoperative pain and foreign body sensation at postoperative day 1 and week 1 were mild to moderate. The chemosis observed 1 h after surgery was minimal, and disappeared quickly during the 1-week follow-up. Conclusion: The T20V is suitable to perform short-duration vitrectomy surgery, and has a low rate of ocular complications, similar to 25- or 23-gauge sutureless vitrectomy systems.

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Section: Discussionsupporting

confidence: 78%

Transconjunctival 20-Gauge Vitrectomy: A Pilot Study

2008

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“…Vitreous incarceration in the sclerotomies could be responsible for anterior vitreoretinal traction. [24][25] We did not observe such complications in our series. The 23-gauge system permitted us to perform a more complete peripheral vitrectomy, with the help of better endo-illumination.…”

Section: Discussioncontrasting

confidence: 55%

23-Gauge transconjunctival sutureless pars plana vitrectomy: results of a prospective study

Schweitzer

Colin

et al. 2009

Eye

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Purpose To evaluate results of 23-gauge transconjunctival sutureless vitrectomy in various indications of vitreoretinal diseases. Design Prospective, non-comparative study. Materials and methods Fifty-seven consecutive eyes of 57 patients underwent vitreoretinal surgery by one surgeon using the 23-gauge, two-step instrumentation developed by Dutch Ophthalmic Research Center Inc., for epiretinal membranes (n ¼ 24), macular holes (n ¼ 10), diabetic retinopathy (n ¼ 4), rhegmatogenous retinal detachment (n ¼ 3), silicone oil removal (n ¼ 10), and other procedures (n ¼ 4). Mean operative time and intraoperative and postoperative complications were recorded. At 1 month, postoperative visual acuity, anatomical results, and induced astigmatism measured by Orbscan (BAUSCH and LOMB laboratories Inc., Rochester, NY, USA) were analysed. Results Mean operative time was 32.6±21.5 min. At 1 month, mean visual acuity improved from 1.09±0.82 to 0.80±0.79 logMar. Transient postoperative hypotony was the most common complication (21.1%), resolving without treatment. There was no choroidal effusion; and no postoperative endophthalmitis was observed. There were no significant changes in mean keratometry (P ¼ 0.957), mean axis (P ¼ 0.818), and power of astigmatism (P ¼ 0.860) at 1 month. Conclusions A 23-gauge vitrectomy seems to be safe and effective for a wide range of indications for vitreoretinal surgery. Further studies are needed to compare it with 25-gauge and 20-gauge vitrectomy in larger series.

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“…[2][3][4][5][6][7] Reported complications include retinal break, retinal detachment, macular hole, cataract progression, hypotony, and breakage of the 25-gauge cutter within the eye. 2,[8][9][10] More concerning, several reports have suggested that the 25-gauge system may result in an increased incidence of postoperative endophthalmitis, [11][12][13][14][15] which can lead to significant morbidity as potential sequelae include irreversible loss of vision. The purpose of this study was to estimate the incidence of endophthalmitis after sutureless 25-gauge vitrectomy surgery and to determine whether there was an increased risk of infection after 25-gauge vitrectomy compared to traditional 20-gauge vitrectomy.…”

Section: Introductionmentioning

confidence: 99%

The incidence of endophthalmitis following transconjunctival sutureless 25- vs 20-gauge vitrectomy

Chen

Khurana

Nguyen

et al. 2008

Eye

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Aim To determine the incidence of endophthalmitis following 25-gauge and standard 20-gauge vitrectomy. Methods In this single-centre retrospective interventional case series, we evaluated the incidence of acute endophthalmitis occurring within the 14-day postoperative period in all patients who underwent pars plana vitrectomy between 1 November 2002 and 31 December 2006. A total of 3477 consecutive patients were identified. Of them, 3046 patients underwent 20-gauge vitrectomy and 431 underwent 25-gauge vitrectomy. Results The event rates of postoperative endophthalmitis were 0.03% (1 of 3046) after 20-gauge vitrectomy and 0.23% (1 of 431) after 25-gauge vitrectomy (P ¼ 0.23). In the endophthalmitis case that occurred after 25-gauge vitrectomy, a combined phacoemulsification cataract surgery was performed with the 25-gauge vitrectomy. Analyses of event rates of postoperative endophthalmitis after combining phacoemulsification cataract surgery and vitrectomy were 0% (0 of 170) for 20-gauge vitrectomy and 2.17% (1 of 46) for 25-gauge surgery vitrectomy (P ¼ 0.21). Conclusion The incidence of postoperative endophthalmitis following 25-gauge vitrectomy and 20-gauge surgery is low. Although there is a trend suggesting an increased risk of endophthalmitis with the 25-gauge system, this difference was not statistically significant given the low number of measured outcomes.

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Postoperative retinal break after 25-gauge transconjunctival sutureless vitrectomy: report of four cases

Abstract: Upon performing 25-gauge TSV for macular hole repair, care should be taken to detect retinal breaks and retinal detachment intraoperatively and postoperatively.

Cited by 26 publications

References 9 publications

Transconjunctival 20-Gauge Vitrectomy: A Pilot Study

Transconjunctival 20-Gauge Vitrectomy: A Pilot Study

23-Gauge transconjunctival sutureless pars plana vitrectomy: results of a prospective study

The incidence of endophthalmitis following transconjunctival sutureless 25- vs 20-gauge vitrectomy

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