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

Abstract

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.

Microincision cataract surgery combined with vitrectomy: a case series

“…This is comparable to the 4.2% posterior capsular breach seen in a similar series of 72 eyes by Krishnan et al, 11 which only looked at PPPV for macular holes. When looking at cataract surgery in vitrectomised eyes, Pardo-Munoz et al 12 found a posterior capsular tear rate of 4% and zonular dialysis of 5%, a much higher complication rate as compared with our series.…”

“…10,11 The results of MICS (1.8 mm) in combination with PPPV have not been presented to our knowledge before. In our study, the IOL was always implanted before proceeding to vitrectomy.…”

“…7 A reason for this may be that there are less chances of a raised IOP in sutureless tranconjunctival vitrectomy, with the cornea more likely to retain clarity due to less intraoperative trauma and less IOP spikes. Krishnan et al 11 have shown that postoperative IOP is significantly higher after 20-G phacovitrectomy compared with 23-G PPPV at day 1 and just below significance at day 7. Most of our cases were 23-G PPPV, which might explain our lower rates of IOP spike in the immediate postoperative period.…”

Predicting Visual Outcome following Surgery for Idiopathic Macular Holes

“…In a comparative study of 47 MH cases, 25-gauge vitrectomy yielded similar visual outcomes, visual acuity and visual improvement at 6 postoperative months to those of 23-gauge vitrectomy [37]. In another comparative study of 72 MH cases, the 23-gauge vitrectomy group had a visual acuity improvement similar to the improvement in the 20-gauge vitrectomy group [38]. In a prospective study of 23 MH cases, the difference in the final visual acuity was not significant between 23- and 20-gauge vitrectomy [39].…”

23-Gauge versus 25-Gauge Vitrectomy for Proliferative Diabetic Retinopathy: A Comparison of Surgical Outcomes

“…Numerous studies have favourably compared aspects of narrow-gauge surgery to traditional sutured 20g surgery [9,10,11]. Studies have also found a reduction in peripheral retinal break formation near the sclerostomy sites with the cannulated sclerostomies used in narrow-gauge systems [12,13].…”