Surgically induced astigmatism after 23-gauge transconjunctival sutureless vitrectomy

Abstract

Purpose: To evaluate surgically induced astigmatism (SIA) after 23-gauge transconjunctival sutureless vitrectomy (23GTSV). Methods: We studied 56 patients (56 eyes) who underwent 23GTSV between January 2006 and December 2007 and who underwent preoperative and 1-and 3-4-months postoperative corneal topography. Fifteen of the 56 patients underwent combined 23GTSV and cataract surgery. SIA was evaluated with Naeser's polar method using the simulated keratometric values obtained with corneal topography. Preoperative and postoperative KP and DKP values were compared in the 23GTSV only group and the combined 23GTSV and cataract surgery group. Results: There were no significant serial changes between the preoperative and postoperative Sim K astigmatism or KP values in the 23GTSV only group. In the 23GTSV only group, the DKP (90) was negative (À0.10 ± 0.78) at 1 month postoperatively, but it became positive (0.13 ± 0.85) at 3-4 months postoperatively. The DKP (135) showed serially decreasing negative values, À0.02±0.80 at 1 month postoperatively and À0.08±0.60 at 3-4 months postoperatively. In the combined cataract surgery group, the 1-and 3-4-month postoperative DKP (135) values were À0.64 ± 0.50 and À0.71 ± 0.48, respectively, which represented a significant decrease compared with the 23GTSV only group (Po0.001, Mann-Whitney U-test). Although statistically insignificant, the DKP (135) value was more negative in the sclerotomy-sutured group (n ¼ 6) than the sclerotomy non-sutured group (n ¼ 35) at 1 month postoperatively (À0.67±1.19 vs 0.09 ± 0.67, P ¼ 0.110, Mann-Whitney U-test). Conclusion: The 23GTSV does not induce significant SIA in the early postoperative period.

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

“…Postoperative cataract formation in the first month is less common in the absence of an intraoperative lens touch [12]. Postoperative astigmatism is demonstrated to be higher with the 20-G system, and it may be attributed to the sclera cautery and suturing at the entry port [13][14][15][16]. Increased postoperative inflammation with the 20-G system has been reported by several studies [5,6,17], which may be explained by the increased surgery duration and the required conjunctival opening with bleeding of conjunctival and episcleral vessels.…”

Combined 23-Gauge Sutureless Vitrectomy and Clear Corneal Phacoemulsification in Patients With Proliferative Diabetic Retinopathy

“…Amplitudes and changes in surgically induced astigmatism in our study were comparable with those in previous reports. 15,16 …”

Comparative study of 23-gauge vitrectomy versus 20-gauge vitrectomy for the treatment of rhegmatogenous retinal detachment

“…More recently, several authors have reported successful anatomic and visual outcomes with transconjunctival sutureless vitrectomy (TSV) in eyes with different vitreoretinal disorders, such as epiretinal membranes [13][14][15][16][17][18][19], macular holes [13,[15][16][17][18][19], vitreous hemorrhage [13,15,16,19,20], and proliferative diabetic retinopathy [13,16,17,19]. This technique gained favor with many vitreoretinal surgeons since complication rates are considered comparable to those reported with 20-gauge (20-G) systems [12,13,17], with less induced astigmatism [14,21] and reduced patient discomfort [18] but conflicting results concerning less surgically induced inflammation [14,22]. All of these studies suggest that 23-G instrumentation is safe and effective for performing vitreoretinal surgery.…”