Long-Term Visual Outcomes and Safety Profile of 27-Gauge Pars Plana Vitrectomy for Posterior Segment Disease

Khan, Mohammed; Kuley, Alexander; Riemann, Christopher D.; Berrocal, María H.; Lakhanpal, Rohit R.; Hsu, Jason; Sivalingam, Arunan; Ho, Allen C.; Regillo, Carl D.

doi:10.1016/j.ophtha.2017.09.013

Cited by 49 publications

(42 citation statements)

References 57 publications

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“…In addition, the 27-gauge vitrectomy probe used in this series features a port placed 0.2 mm from the tip. Having a port so close to the edge of the probe allows greater precision and fewer tractional manoeuvres [20]. In our comparative study, we recorded no cases of iatrogenic tears in either group, and both 27-gauge and 25-gauge instrumentation were adequate in obtaining precise dissection also in the cases complicated by PVR.…”

Section: Discussionmentioning

confidence: 83%

A Propensity-Score Matching Comparison between 27-Gauge and 25-Gauge Vitrectomy Systems for the Repair of Primary Rhegmatogenous Retinal Detachment

Veritti

Sarao

Lanzetta

2019

Journal of Ophthalmology

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Purpose To compare the anatomical and visual results and complications of 27-gauge versus 25-gauge transconjunctival sutureless vitrectomy for the management of primary rhegmatogenous retinal detachment. Methods A prospective, propensity score-matched 6-month study was performed. All patients underwent either 27-gauge or 25-gauge vitrectomy as the first surgical intervention and were followed up over a 6-month period, in order to evaluate anatomical success, change in best-corrected visual acuity (BCVA), and intraoperative and postoperative complications including intraocular pressure dysregulation. Results Propensity score matching resulted in two groups of 37 eyes each. All eyes completed a six-month follow-up. Baseline demographic and preoperative ocular characteristics showed no statistically significant difference between the two cohorts. The single operation success rate was 33/37 (89%) for 27-gauge cases and 34/37 (92%) for 25-gauge cases (p=0.7). The final anatomical success rate was 100% for each of the two cohorts. Mean BCVA change at the 6-month postoperative follow-up visit was −0.67 logMAR in the 27-gauge group and −0.71 logMAR in the 25-gauge group (p=0.9). Two patients in the 25-gauge group experienced transient hypotony after surgery. Conclusion No significant difference between 27-gauge and 25-gauge transconjunctival sutureless vitrectomy for the repair of primary rhegmatogenous retinal detachment was recorded in terms of reattachment rate, BCVA, intraoperative and postoperative complications.

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Section: Discussionmentioning

confidence: 83%

A Propensity-Score Matching Comparison between 27-Gauge and 25-Gauge Vitrectomy Systems for the Repair of Primary Rhegmatogenous Retinal Detachment

Veritti

Sarao

Lanzetta

2019

Journal of Ophthalmology

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“…An epiretinal membrane (ERM) is a thin layer of fibrous tissue that can form on the inner surface of the central retina, causing metamorphopsia, monocular diplopia, and decreased vision [1][2][3]. Recent advances in microincision vitrectomy surgery (MIVS) and ERM removal with internal limiting membrane (ILM) peeling have improved surgical safety and visual outcomes for ERM patients [4][5][6][7]. However, ILM peeling is still a difficult technique and can inflict mechanical stress on the central retina, including the nerve fiber layer and ganglion cell layer [8][9][10].…”

Section: Introductionmentioning

confidence: 99%

Efficacy of 27-Gauge Vitrectomy with Internal Limiting Membrane Peeling for Epiretinal Membrane in Glaucoma Patients

Yoshida

Kunikata

Kunimatsu-Sanuki

et al. 2019

Journal of Ophthalmology

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is properly cited.Purpose. To evaluate the efficacy of epiretinal membrane (ERM) surgery for patients with ERM and glaucoma. Methods. We reviewed the medical records of 20 consecutive ERM patients with glaucoma, who underwent 27-gauge microincision vitrectomy surgery (27GMIVS) with internal limiting membrane (ILM) peeling. e preoperative and 6-month postoperative visual field was tested with the Humphrey Field Analyzer (HFA) 24-2 program. Changes in threshold sensitivity in the HFA test points were analyzed point-by-point, with points classified into groups based on sensitivity as abnormal (less than 5th percentile in pattern deviation) or normal (all other points) and based on location as central (12 central points) or peripheral (all other points) with a linear mixed-effects model. Results. Visual acuity and mean deviation improved postoperatively (P < 0.001 for both) in all patients. reshold sensitivity in central or peripheral points that were abnormal preoperatively improved postoperatively (P � 0.006 or P < 0.001, respectively). reshold sensitivity also improved in the central normal test points (P � 0.03), but not in the peripheral normal points (P � 0.12). Conclusion. Visual acuity improved, and there was no visual field progression, after ERM surgery in glaucomatous eyes during a 6-month postoperative follow-up, suggesting that ERM and ILM removal using 27GMIVS may be effective even in glaucomatous eyes.

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“…In this light, in macular surgery the surgeon's goal could be to achieve maximal vitreous removal without indentation, at least at the sclerotomy site, in order to intentionally leave a minimal but sufficient quantity of peripheral vitreous skirt in order to plug the sclerotomy. In our practice, the attempt to achieve maximal vitreous removal is already ongoing and could explain the relatively high rate of suturing (13.8%) experienced in the present series, especially in consideration of the fact that the tamponade with air or gas, performed in every patient in this series, should favour the competency of the sclerotomy [31,32]. Additionally, if our results could be applied to other clinical scenarios which require more aggressive vitreous base dissection-i.e., rhegmatogenous retinal detachment in high myopia-the surgeon may opt to intentionally leave a residual skirt of vitreous around the infusion line in order to avoid eye collapse at the end of the surgery.…”

Section: Discussionmentioning

confidence: 83%

Vitreous incarceration in sutured vs non-sutured sclerotomies after 25-gauge macular surgery

Tosi

Malandrini

Bacci

et al. 2020

Eye

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Objectives To study the patterns of vitreous incarceration in sutured vs non-sutured sclerotomies in patients subjected to 25gauge macular surgery. Methods A prospective study of 135 eyes affected by epiretinal membrane or macular hole. Vitreal disposition was evaluated via ultrasound biomicroscopy (UBM) at the sclerotomy sites between 30 and 40 days after surgery, once the tamponade had completely disappeared. Results In total, 349 sclerotomies (86.2%) of 99 patients were non-sutured while 56 sclerotomies (13.8%) of 36 patients were sutured at the end of the surgical procedure. Among the 36 patients with sutured sclerotomies, 15 out of 36 (41.6%) had at least two sclerotomies sutured. All the sclerotomy sites were evaluated (405 sclerotomies). Sclerotomy suture was significantly associated with a less aggressive pattern of vitreal incarceration (OR: 0.16, 95% CI: 0.07-0.35, p < 0.001). Compared to preoperative values, day 1 post operative IOP was not significantly different in patients with sutured sclerotomies, while patients with non-sutured sclerotomies had a significantly lower day 1 post operative IOP. Conclusions In 25-gauge macular surgery, UBM evaluation documented a higher rate of postoperative vitreous incarceration in the non-sutured sclerotomies, confirming the previously postulated role of the residual vitreous, left at the end of the surgery, in closing the sclerotomy site.

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Long-Term Visual Outcomes and Safety Profile of 27-Gauge Pars Plana Vitrectomy for Posterior Segment Disease

Cited by 49 publications

References 57 publications

A Propensity-Score Matching Comparison between 27-Gauge and 25-Gauge Vitrectomy Systems for the Repair of Primary Rhegmatogenous Retinal Detachment

A Propensity-Score Matching Comparison between 27-Gauge and 25-Gauge Vitrectomy Systems for the Repair of Primary Rhegmatogenous Retinal Detachment

Efficacy of 27-Gauge Vitrectomy with Internal Limiting Membrane Peeling for Epiretinal Membrane in Glaucoma Patients

Vitreous incarceration in sutured vs non-sutured sclerotomies after 25-gauge macular surgery

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