Comparison of the 20-Gauge Conventional Vitrectomy Technique with the 23-Gauge Releasable Suture Vitrectomy Technique

Abstract

PurposeTo compare the efficacy of the transconjunctival releasable suture technique for pars plana vitrectomy using 23-gauge (23G) instruments versus the conventional 20-gauge (20G) technique.MethodsA retrospective and interventional case series was consecutively performed for 199 eyes of the 192 patients that were a part of this study. Clinical data were reviewed retrospectively regarding the operation time, preoperative and postoperative intraocular pressure, visual acuity and astigmatism for 54 consecutive patients who received a 23G releasable suture vitrectomy and for 98 consecutive patients who received a 20G conventional vitrectomy during the period between April 2007 and September 2010.ResultsMean operation time based on the operation record was 88.5 ± 20.1 minutes in the 23G releasable suture vitrectomy group and 102.1 ± 23.1 minutes in the 20G conventional vitrectomy group, respectively (p = 0.01). The last best-corrected visual acuity (BCVA) was significantly better than the preoperative BCVA in both patient groups (p = 0.01, p = 0.01). The 23G releasable suture group showed less surgically induced astigmatism than the 20G conventional vitrectomy group. Vitreous bleeding was observed to be in 6 eyes (5.9%) in the 23G group, and in 8 eyes (8.2%) in the 20G group. In addition, ocular hypertension was noted to be in 3 eyes (3.0%) in the 23G group, and 6 eyes (6.1%) in the 20G group. No serious complications such as postoperative hypotony or endophthalmitis were observed in either group.ConclusionsThe 23G releasable suture technique is as effective as the 20G conventional technique and offers several advantages.

Comparison of 23 gauge transconjunctival releasable Suture Vitrectomy with standard 20 gauge Vitrectomy

“…They reported that the mean operation time was 88.5 ± 20.1 in the 23G vitrectomy group and 102.1 ± 23.1 minutes in the 20G conventional group, respectively ( p =0.01). 13 This result was similar to results reported in our study. The difference in the surgical duration was mainly because of opening and closing time required with 20G vitrectomy despite that 20G vitrectomy is quicker once we exclude the opening and closing time required before starting vitrectomy.…”

“…as compared to those requiring partial vitrectomy (macular hole, epiretinal membrane etc). This observation is comparable to another such study conducted recently by Kim et al 13 …”

“…The difference in the surgical duration was mainly because of opening and closing time required with 20G vitrectomy despite that 20G vitrectomy is quicker once we exclude the opening and closing time required before starting vitrectomy. 13 …”

“…Although there have been studies where effectiveness and safety of releasable vicryl sutures has been documented, we wanted to perform this technique in local population since local literature lacks the evidence of effectiveness of this technique. 13 , 14 Given the simplicity of technique, we performed the following study to evaluate its effectiveness.…”

Trends in the characteristics of vitrectomy in Eastern China

“…As previous studies have shown, the 23G PPV system is less invasive than 20G PPV, and the incidence of early-onset ocular hypertension in patients treated with 23G PPV is lower than that in patients treated with 20G PPV. 2 , 3 Furthermore, macular disease presents a lower risk of elevated IOP after PPV than other vitreoretinal disorders. 25 , 26 Therefore, the reduced use of IOP-lowering drugs might be the result of more refined PPV instruments and procedures and the increase in the proportion of patients with macular diseases.…”