Does 23-Gauge Sutureless Vitrectomy Modify the Risk of Postoperative Retinal Detachment After Macular Surgery?

Rouic, Jean-François Le; Becquet, F.; Ducournau, D

doi:10.1097/iae.0b013e3182069aa4

Cited by 25 publications

(13 citation statements)

References 28 publications

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“…In all cases and especially the latter, it was imperative to carry out a full 360-degree examination with indentation, to exclude any iatrogenic retinal breaks. In our study, there were no cases of immediate or late post-vitrectomy RRD, a finding consistent with Le Rouic et al 12 We suggest part of the reason for this is that the surgeon used combined phacoemulsification and PPV, which enabled an unimpeded view to the vitreous base. This allowed better shaving of the vitreous gel for a more extensive peripheral vitrectomy as well as better visualisation and prompt treatment of iatrogenic breaks.…”

Section: Discussionsupporting

confidence: 77%

Risk factors for iatrogenic retinal breaks induced by separation of posterior hyaloid face during 23-gauge pars plana vitrectomy

Rahman

Murray

Stephenson

2013

Eye

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Purpse To describe the incidence and features of intraoperative retinal breaks caused by induction of posterior hyaloid face (PHF) separation during 23-gauge pars plana vitrectomy (PPV). Methods A prospective, consecutive, single surgeon, observational study of patients undergoing 23-gauge transconjunctival sutureless vitrectomy for macular pathology or floaters, was carried out between 2009 and 2011 at Calderdale Royal Hospital, UK. PHF separations were categorised as either suction induced or requiring membrane blue (DORC Limited) with suction (adherent). The outcome measure was dichotomised into retinal break or tear and no retinal break or tear. Forced entry and parsimonious multiple logistic regression analyses were conducted, using statistical software, to test for significance of association of the set of recorded factors and covariates with the dichotomised outcome measure. Results Data were collected and analysed from 137 patients. The incidence of iatrogenic retinal breaks associated with PHF separation during 23-gauge PPV was 18.2%. Under both forced entry and parsimonious multiple logistic regression models, the odds of a retinal break or tear reduce by about 3-4% for each increasing year of age. Findings also showed some substantive association in the forced entry model, with the odds of a retinal break or tear for adherent cases being around 3.8 times those for suctiononly cases.Conclusions Mechanical detachment of the PHF represents an important risk factor in the formation of retinal breaks. Particular care should be taken to examine intraoperatively for iatrogenic breaks in order to prevent missed breaks and subsequent rhegmatogenous retinal detachments.

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Section: Discussionsupporting

confidence: 77%

Risk factors for iatrogenic retinal breaks induced by separation of posterior hyaloid face during 23-gauge pars plana vitrectomy

Rahman

Murray

Stephenson

2013

Eye

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“…Accordingly, less retinal detachments have been observed after transconjunctival vitrectomy for macular surgery. 22 23 …”

Section: Discussionmentioning

confidence: 99%

Vitrectomy with and without encircling band for pseudophakic retinal detachment: VIPER Study Report No 2—main results

et al. 2016

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BackgroundIt is unclear whether or not an additional encircling band improves outcome in vitrectomy for pseudophakic retinal detachment (PRD). Also unclear is whether small gauge transconjunctival trocar-guided vitrectomy is as successful as conventional 20 gauge (G) vitrectomy.Methods257 adult patients with uncomplicated PRD were enrolled in 14 vitreoretinal centres across Germany. Contingent on availability of qualified surgeons, eligible patients were randomly assigned either (i) with ratio 1:1 to 20 G vitrectomy plus encircling band (group E1) or 20 G vitrectomy without any buckle (group C) or (ii) with ratios 1:1:1 to group E1, C or 23/25 G vitrectomy without any buckle (group E2). Treatment success was defined as no indication for any retina reattaching procedure during the follow-up of 6 months.ResultsSuccess was reached in 79.0% (=79/100, group E1) versus 73.5% (=72/98, group C) (p=0.558, OR 1.32, 95% CI 0.65 to 2.65. In group E2 87.7% (=50/57) of patients reached success compared with 78.7% (=48/61) in group C, demonstrating non-inferiority of E2 to C regarding the prespecified margin of 0.8 (OR scale; p=0.05, OR 2.17, 95% CI 0.80 to 5.89). Best corrected visual acuity significantly increased after surgery independent of technique, that is, on average −0.7 (from 1.0 to 0.3) logMAR. Patients suffered from a shift in spherical refraction of −1.0 D in group E1 compared with −0.1 D in group C. Similarly, intraoperative complications (15.2% vs 8.8% of patients) and serious adverse events (30.3% vs 22.5% of patients) were more frequent in group E1.ConclusionsVitrectomy with gas is an efficient and safe treatment for uncomplicated PRD. An additional encircling band does not significantly reduce the risk for any second procedure necessary to reattach the retina in 20 G vitrectomy. Small gauge transconjunctival vitrectomy is not inferior to the conventional 20 G technique.Trial registration numberDKRS 00003158, Results.

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“…Posto- 2-3,4), postoperatif endoftalmi (%1,6-2,4), postoperatif vitreus hemorajisi (%1,2-5,2) bildirilmiştir. 8,16,18,29 Sonuç olarak, ERM'li olgularda TM ve BM kullanılarak çift boyama yöntemi ile 23-G TSV uygulaması ile başarılı sonuçlar alınabilmektedir. Bu şekilde hem ERM hem İLM'nin ayrı ayrı boyanmaları sağlanmakta ve ERM soyulmasını takiben retina yüzeyinde kalan İLM tamamen soyulabilmektedir.…”

Section: Gereç Ve Yöntemunclassified

“…[13][14][15] Çeşitli çalışmalarda, 23-G transkonjonktival sütürsüz vitrektomi (TSV) yöntemi ile ERM soyulmasının etkinliği ve güvenirliği bildirilmiştir. [16][17][18] Ancak literatürde, 23-G TSV ile TM ve BM'nin birlikte kullanıldığı çift boyama yöntemi ile ERM cerrahisi yapıldığını bildiren bir çalışma yoktur.…”

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Epiretinal Membrane Surgery with 23-Gauge Transconjunctival Sutureless Vitrectomy Using Double Staining Technique

Horozoğlu¹,

Yanyali²,

Maçin³

et al. 2012

Turkiye Klinikleri J Med Sci

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Ö ÖZ ZE ET T A Am ma aç ç: : Epiretinal membranlarda (ERM), tripan mavisi (TM) ve brilliant mavisi (BM) ile çift-boyama yöntemi kullanılarak uygulanan 23-gauge (23-G) transkonjonktival sütürsüz vitrektomi (TSV) sonuçlarını irdelemek. G Ge er re eç ç v ve e Y Yö ön nt te em ml le er r: : Bu çalışmada, primer ERM tanısı ile 23-G TSV uygulanan 15 hastanın 15 gözü retrospektif olarak incelendi. ERM soyulması sırasında TM, iç limitan membran (İLM) soyulması sırasında BM ardışık olarak kullanıldı. Çalışmamızda temel olarak görme keskinliği, göz içi basıncı, intraoperatif ve postoperatif komplikasyonlar parametreleri incelendi. İstatistiksel analizlerde Wilcoxon testi kullanıldı. B Bu ul lg gu ul la ar r: : Hastalar ortanca 4 ay (1-11 ay) boyunca takip edildi. Postoperatif olarak olguların tümünde, preoperatif olarak optik koherens tomografi incelemesinde saptanan ERM görüntüsünün kaybolduğu gözlendi. Preoperatif görme keskinlikleri 2 metreden parmak sayma (mps) ile 5/10 arasında değişmekte iken, postoperatif en son muayenede görme keskinliği 1/10 ile 9/10 arasında idi. Olguların ortanca logMAR görme keskinliği preoperatif 0,5 (0,30-1,60) iken, postoperatif 0,4 (0,10-1,18) bulundu (p=0,039, Wilcoxon testi). Olguların 9 (%60)'unda görme keskinliği 2 sıra ve üzerinde artarken, 6 olguda (%40) görme keskinliğinde 2 sıradan az değişim gözlendi. Ortanca göz içi basıncı preoperatif 15 (11-16) mmHg, postoperatif 14 (8-21) mmHg saptandı (p=0,685, Wilcoxon testi). Postoperatif dönemde 1 olguda (%6,7) cerrahi gerektiren katarakt, 1 olguda (%6,7) regmatojen retina dekolmanı gözlendi. ERM nüksüne rastlanmadı. S So on nu uç ç: : Çift boyama yöntemi kullanılarak uygulanan 23-G TSV, ERM cerrahisinde etkin ve güvenli bir yöntem gibi görünmektedir. Daha çok olgu sayısı içeren prospektif ça-lışmalar ile yöntemin etkinliği daha iyi değerlendirilebilecektir.A An na ah ht ta ar r K Ke el li im me el le er r: : Epiretinal membran; vitrektomi; coomassie brilliant blue; tripan mavisi A AB BS ST TR RA AC CT T O Ob bj je ec ct ti iv ve e: : To evaluate the 23-gauge (23-G) transconjunctival sutureless vitrectomy (TSV) results for epiretinal membranes (ERM) using double-staining technique with trypan blue (TB) and brilliant blue (BB). M Ma at te er ri ia al l a an nd d M Me et th ho od ds s: : In this study, 15 eyes of 15 patients who underwent 23-G TSV for primary ERM were retrospectively reviewed. TB was used for ERM removal and BB was used for inner limiting membrane (ILM) removal, consecutively. Main outcome measures were visual acuity, intraocular pressure, and intraoperative and postoperative complications. Wilcoxon test was used for statistical analysis. R Re es su ul lt ts s: : Median follow-up was 4 months (range, 1-11 months). ERM, which was present in preoperative optical coherence tomography scanning, was not detected postoperatively in any of the eyes. Preoperative visual acuity was between counting fingers from 2 meters and 2/10, whereas it was between 1/10 and 9/10 postoperatively. Median log-MAR visual acuity was 0.5 (0.30-1.60) pr...

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Does 23-Gauge Sutureless Vitrectomy Modify the Risk of Postoperative Retinal Detachment After Macular Surgery?

Abstract: After a short-term follow-up, a lower rate of postoperative RD was observed in the 23-gauge group. Sutureless 23-gauge vitrectomy appears safe when considering the risk of postoperative RD. Prospective and long-term studies are still needed to confirm these results.

Cited by 25 publications

References 28 publications

Risk factors for iatrogenic retinal breaks induced by separation of posterior hyaloid face during 23-gauge pars plana vitrectomy

Risk factors for iatrogenic retinal breaks induced by separation of posterior hyaloid face during 23-gauge pars plana vitrectomy

Vitrectomy with and without encircling band for pseudophakic retinal detachment: VIPER Study Report No 2—main results

Epiretinal Membrane Surgery with 23-Gauge Transconjunctival Sutureless Vitrectomy Using Double Staining Technique

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