Comparison of retinal breaks observed during 23 gauge transconjunctival vitrectomy versus conventional 20 gauge surgery for proliferative diabetic retinopathy

Issa, Sharif A; Connor, Alan; Habib, Maged; Steel, David

doi:10.2147/opth.s16414

Cited by 50 publications

(37 citation statements)

References 21 publications

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“…However, we did not find this difference comparing the 23g and 25g groups. Several papers have reported that significantly fewer peripheral retinal breaks are caused by cannulated 23g systems compared to the 20g [12,13,29]. Our entry site break rate was very low in both groups at 1 eye in each group as may have been expected since the cannulated sclerostomy system is identical in length in each gauge at 6 mm.…”

Section: Discussionsupporting

confidence: 56%

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

2014

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Purpose: This study compared clinical outcomes and complications between 23-gauge (23g) and 25-gauge (25g) transconjunctival sutureless vitrectomy in patients with proliferative diabetic retinopathy. Study Design: It was a retrospective study using data prospectively defined and collected. 80 eyes underwent 23g transconjunctival sutureless vitrectomy, and 80 eyes underwent 25g surgery using the same vitrectomy system by one surgeon. Primary outcome measures were best-corrected visual acuity, intraocular pressure (IOP), and incidence of intraoperative and postoperative complications. Results: Vision was significantly improved after intervention in both groups (p ≥ 0.0001). There was no significant difference in visual outcomes between the groups (p = 0.43) or in the type and frequency of retinal breaks occurring during surgery (p = 0.63). The 23g group had significantly more patients with a day 1 IOP of <6 mm Hg (p = 0.034) and significantly more patients requiring a sclerostomy suture postoperatively (p = 0.014). Conclusion and Message: Both gauges are equally effective for the treatment of proliferative diabetic retinopathy.

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Section: Discussionsupporting

confidence: 56%

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

2014

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“…Contrary to this, Issa SA et al (2011) observed that 23-gauge transconjunctival vitrectomy surgery was associated with a lower rate of retinal break formation than 20 gauge vitrectomy for proliferative diabetic retinopathy (5 % vs 14%).…”

Section: Khanduja S Et Al Minimally Invasive Vitrectomy Surgery Inmentioning

confidence: 57%

Surgical outcomes of minimally invasive vitrectomy surgery in Eales’ disease

et al. 2013

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Introduction: The results of surgical outcomes of 20 gauge pars plana vitrectomy in Eales' disease are available in the scientific literature. However, all these studies have been done using the 20 gauge vitrectomy systems and most studies have been conducted in a retrospective manner. Objective: To evaluate the outcomes and safety of 23 gauge vitrectomy in complications of Eales' disease. Materials and methods: Study design: Consecutive interventional case series. Participants: Seventy-six eyes of 72 nonconsecutive patients undergoing 23-gauge vitrectomy for complications of Eales' disease were enrolled. The participants were followed up for a minimum of one year. Intervention: The participants underwent a complete demographic, medical and ophthalmic evaluation. A 23-gauge vitrectomy was performed. Endotamponade was used when necessary. Perioperative and postoperative events were recorded. Primary outcome measures were visual acuity and complications arising due to surgery. Results: Indication for surgery was non-clearing vitreous hemorrhage in 89.4% (68/76) and secondary retinal detachment in 10.6% (8). Visual acuity improved from Log Mar 1.80 ± 0.19 units preoperatively to Log Mar 0.47±0.59. Best-corrected visual acuity equivalent to Snellen 6/9 was achieved in 77. 6% of eyes. . Surgical failure was seen in 6.5% cases. Four cases were lost due to progression to neovascular glaucoma and 1 case was lost to severe residual retinal detachment. Iatrogenic portside retinal breaks occurred in 3.9% (3), post-vitrectomy retinal detachment 2.6% ( 2), hypotony 1.3% (1) and cataract in 38.1% (28) cases. Conclusion: 23-gauge sutureless vitrectomy in patients with Eales' disease is a safe and effective technique with acceptable level of risk and complications.

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“…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.…”

Section: Resultsmentioning

confidence: 99%

“…The submacular surgery trial 13 and diabetic retinopathy vitrectomy study 14 were undertaken before the widespread introduction of wide-angle viewing systems and small-gauge surgery, which may alter the detection and occurrence of retinal breaks, respectively. 11,12 There are recent, large prospective studies of PPV for the treatment of retinal detachment, 15,16 and these reported that iatrogenic retinal breaks occur in 8-13% of cases, 16 a The value shown is the percentage of all eyes undergoing pars plana vitrectomy (PPV), despite the fact that lens touch would not occur in a pseudophakic eye. Of the 6986 eyes undergoing primary PPV, 668 had previously had cataract surgery and were therefore known to be pseudophakic, 1897 had combined PPV and cataract surgery and were therefore phakic at the time of their primary PPV, and 1238 subsequently had cataract surgery and were therefore also known to be phakic during their primary PPV.…”

Section: Resultsmentioning

confidence: 99%

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

Jackson

Donachie

Sparrow

et al. 2013

Eye

109

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Aim To report the vitreoretinal (VR) surgical case mix in the United Kingdom, the intraoperative complication rate of pars plana vitrectomy (PPV), and the incidence of postvitrectomy cataract extraction. Methods Participating hospitals prospectively collected ophthalmic data using a single electronic medical record system, with automatic extraction of anonymised data to a national database. This study included the subset of 11 618 VR operations undertaken on 9619 eyes, of 8741 patients, over 8 years, from 27 sites. Surgical data included the indication for surgery, all procedure elements, and whether or not an intraoperative complication occurred. Postvitrectomy cataract data were also analysed. The main outcome measures were a description of the indications for surgery, intraoperative PPV complication rate, and percentage of eyes undergoing postvitrectomy cataract surgery (PVCS). Results The most common indications for VR intervention were retinal breaks and rhegmatogenous retinal detachment (48.5%), macular hole (9.8%), epiretinal membrane (9.6%), and diabetic eye disease (7.3%). Overall, 7.8% of PPVs had at least one intraoperative complication-the most common were iatrogenic retinal breaks (3.2%), and lens touch (1.2-1.6% of phakic eyes). PVCS occurred in 50.2, 68.7, and 74.0% of eyes at 1, 2, and 3 years, respectively.Conclusion VR surgery is undertaken for a wide range of conditions, but a small number of diagnoses encompass the majority of cases. Intraoperative PPV complications are not uncommon, and post-vitrectomy cataract is to be expected in most phakic eyes.

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Comparison of retinal breaks observed during 23 gauge transconjunctival vitrectomy versus conventional 20 gauge surgery for proliferative diabetic retinopathy

Cited by 50 publications

References 21 publications

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

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

Surgical outcomes of minimally invasive vitrectomy surgery in Eales’ disease

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

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