23-gauge sutureless vitrectomy and 20-gauge vitrectomy: a case series comparison

Abstract

Purpose To directly compare the per-operative safety and efficacy of the 20-and 23-gauge vitrectomy systems as well as day 1 intraocular pressure (IOP). Methods Data were collected on 50 consecutive vitrectomy cases performed using the 20-gauge system and 23-gauge sutureless vitrectomy. All surgeries were carried out by one surgeon (RLB) at a single centre. Data collected prospectively included indication for surgery, iatrogenic retinal tears, and operating times. Results Most common indications for surgery were macular hole, rhegmatogenous retinal detachment, diabetic vitreous haemorrhage (no tractional retinal detachment), and macular pucker. Intraocular tamponade with air, sulphur hexafluoride (SF6), hexafluoroethane (C2F6) or octafluoropropane (C3F8), or silicone oil was used in 25 patients in the 20-gauge group and 46 patients in the 23-gauge group. One scleral port required suture in patients who underwent 23-gauge vitrectomy (0.67%). Every 20-gauge patient had all the three ports sutured. The mean first day IOP was 22.88 mm Hg in the 20-gauge vs 17.58 mm Hg in the 23-gauge (Po0.001). Four patients in the 20-gauge group had an IOP 440 mm Hg compared to none in the 23-gauge group. In contrast, four patients had postoperative hypotony in the 23-gauge group compared to none in the 20-gauge group. The mean operating time for all the 50 cases in each group was 39.4 (20 gauge) vs 29 min (23 gauge) Po0.001. Conclusion Our study indicates less risk of considerably raised IOPs and reduced surgical operating time with the 23-gauge system. Additional advantages observed included faster wound healing, diminished conjunctival scarring, improved patient comfort, and decreased postoperative inflammation.

United Kingdom National Ophthalmology Database Study of Vitreoretinal Surgery: Report 1; Case mix, complications, and cataract

“…PPV was found to have an intraoperative complication rate of 7.8%, with iatrogenic retinal tears by far the most frequent complication at 3%, followed by lens touch at [8][9][10][11][12] It can, however, be difficult to compare across series, as authors use different definitions of entry site break, and iatrogenic breaks. There is also a risk of publication bias, if clinicians are reluctant to report high complication rates, and the outcomes in case series of clinical interest may not be generalisable, due to their complex nature or targeted case selection.…”

Comparison of 25- and 23-gauge sutureless microincision vitrectomy surgery in the treatment of various vitreoretinal diseases

“…[3][4][5][6][7][8][9][10][11][12] Furthermore, a few recent reports continue to prove the superiority of MIVS in direct comparison with conventional 20-gauge vitrectomy. 6,7,[14][15][16][17] Although the makers of each of two commercially available small gauges, 25 and 23 gauges, claim to offer the safest and best product, no studies have yet compared the 25-and 23-guage systems.…”

“…Although a few studies have compared these minimally invasive MIVS approaches with conventional 20-gauge vitrectomy, 6,7,[14][15][16][17] no comparison between 25-and 23-gauge MIVS has yet been reported.…”

Comparison of postoperative intraocular pressure changes between 23-gauge transconjunctival sutureless vitrectomy and conventional 20-gauge vitrectomy

“…3 As it has only recently been developed, studies on the efficacy and safety of 23-gauge TSV have been limited, [5][6][7][8][9][10][11] and few comprehensive comparisons with conventional 20-gauge vitrectomy for limited indications of vitrectomy have been performed. 12,13 Specifically, in regard to postoperative hypotony or hypertony, although those are the major complications of vitrectomy, there have been few comparative studies with inconclusive number of patients. These studies were also limited in that only the intraocular pressure (IOP) at postoperative day 1 was studied and compared.…”