Outcomes of transconjunctival sutureless 27-gauge vitrectomy for vitreoretinal diseases

Li, Jie; Liu, Sanmei; Dong, Wentao; Li, Fang; Zhou, Chang; Xu, Xinglian; Zhong, Jie

doi:10.18240/ijo.2018.03.10

Cited by 13 publications

(21 citation statements)

References 24 publications

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“…An adequate membrane peeling was achieved with both 25-gauge and 27-gauge forceps. It is important to note that, with its smaller diameter, the 27-gauge cutter can more easily be placed in the space between the retina and the PVR membrane, which is helpful in membrane dissection [21].…”

Section: Discussionmentioning

confidence: 99%

“…According to the Hagen-Poiseuille law, this should theoretically result in a decrease in the flow rate by approximately 60%. However, dual pneumatically operated vitrectomy probes with ultrahigh cut rates (7500 cpm) can maintain an efficient vitreous flow rate [21]. High cut rate lowers vitreous viscosity, resulting in reduced resistance to flow.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

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: 99%

Section: Discussionmentioning

confidence: 99%

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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“…This may be due to lower flow/suction in 27G instrumentation and has been reported by other authors. 6 By controlling for variables in a multiregression analysis, we revealed no association with indication for surgery, age, sex or axial length. Despite the high incidence of breaks, none of the patients in our series developed an immediate or late postoperative rhegmatogenous retinal detachment.…”

Section: Discussionmentioning

confidence: 74%

“…4 Since the initial report of a 27G transconjunctival sutureless vitrectomy system by Oshima and colleagues, 5 this technique has being widely adopted. While various authors [6][7][8][9] have confirmed its safety and efficacy compared to traditional smallgauge vitrectomy systems, the risk for iatrogenic retinal breaks has not been quantified thus far.…”

Section: Introductionmentioning

confidence: 99%

The Incidence of Retinal Breaks Induced by Posterior Hyaloid Separation During 27-Gauge Pars Plana Vitrectomy

Rahman

Patil

Stephenson

2019

Journal of VitreoRetinal Diseases

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Purpose: As advances are made in smaller-gauge vitrectomy, it is important to characterize the associated risks. This allows the surgeon to anticipate complications and appropriately counsel patients. The incidence of iatrogenic retinal breaks in 25- and 23-gauge (G) vitrectomy is known, but no studies exist looking at the incidence in 27G vitrectomy with an attached posterior hyaloid face (PHF). This study set out to characterize the incidence. Methods: A retrospective, consecutive, observational study of patients undergoing 27G transconjunctival sutureless vitrectomy for macular pathology or floaters was conducted. This was a single-surgeon series conducted between 2015 and 2017 at Calderdale Royal Hospital, United Kingdom. Inclusion criteria included only those with an attached PHF at the disc, identified intraoperatively. Results: Data were collected and analyzed in 94 patients. Preoperative diagnosis frequency was as follows: epiretinal membrane 24 (25.5%), macular hole 47 (50.0%), vitreomacular traction 11 (11.7%), and floaters 12 (12.8%). In 82 out of 94 patients (89.1%), 27G vitrectomy was combined with 2.2 mm microincisional phacoemulsification with lens implantation. The incidence of iatrogenic retinal breaks associated with PHF separation during 27G PPV was 17% (16 cases). Conclusions: This is the first study to report the incidence of peripheral retinal breaks induced by PHF separation during 27G vitrectomy. Our single-surgeon case series of 27G PPV for all elective vitreoretinal indications, in eyes with attached vitreous, yielded an iatrogenic break rate of 17%. However, no postoperative retinal detachments followed. Statistical analysis revealed no specific risk factors to be significantly associated with outcome (incidence of retinal tear).

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“…Micro-Incision Vitrectomy Surgery (MIVS) offers an excellent safety profile for patients, while the newest 27-gauge (27G) systems have potential additional safety and outcome benefits when compared to earlier MIVS platforms. This innovation towards progressively smaller instrumentation is playing a major role in the evolution of posterior segment surgery by allowing for decreased incision size and, possibly, less pain, [ 1 , 2 ] fewer post-surgical wound leaks and subsequently, faster recovery times [ 3 – 5 ] with a low risk of other post-operative complications ( 6 – 8 ). Specifically, multiple large cohort studies and a 2013 literature review concluded there was no increased risk of endophthalmitis when comparing MIVS to 20-gauge (20G) vitrectomy [ 9 – 12 ].…”

Section: Introductionmentioning

confidence: 99%

25 vs. 27-gauge micro-incision vitrectomy surgery for visually significant macular membranes and full-thickness macular holes: a retrospective study

et al. 2020

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Background To evaluate visual and safety outcomes for 25-gauge (25G) and 27-gauge (27G) micro-incision vitrectomy platforms (MIVS) for the treatment of epiretinal membrane and full-thickness macular holes. Methods Retrospective analysis of all patients who underwent internal limiting membrane (ILM) peel surgery from January 2017 through December 2018. 207 cases met the eligibility criteria for inclusion. Primary endpoint was post-operative Best-Corrected Distance Visual Acuity (BCVA) at 6 months. Results For all patients combined, mean logMAR BCVA improved from 0.57 (± 0.40) to 0.37 (± 0.36) post-operatively (p < 0.001). For 25G ERMs, logMAR BCVA improved from 0.51 (± 0.28) to 0.30 (± 0.25) post-operatively (p < 0.001). For 27G ERMs, logMAR BCVA improved from 0.33 (± 0.28) to 0.28 (± 0.27) post- operatively (p = 0.15). For 25G FTMHs, logMAR BCVA improved from 0.87 (± 0.48) to 0.51 (± 0.44) post-operatively (p < 0.001). For 27G FTMHs, logMAR BCVA changed from 0.89 (± 0.47) to 0.96 (± 0.60). Conclusion Final visual outcomes improved for both 25G and 27G ERM groups and the 25G FTMH group. Both 25G and 27G were safe and well tolerated MIVS platforms for the treatment of ERM and FTMH.

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Outcomes of transconjunctival sutureless 27-gauge vitrectomy for vitreoretinal diseases

Abstract: The current results suggest that 27G PPV system is a safe and effective treatment for various vitreoretinal diseases. When learning to perform 27G PPV, surgeons may encounter a learning curve and should gradually expand surgical indications from easy to pathologically complicated cases.

Cited by 13 publications

References 24 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

The Incidence of Retinal Breaks Induced by Posterior Hyaloid Separation During 27-Gauge Pars Plana Vitrectomy

25 vs. 27-gauge micro-incision vitrectomy surgery for visually significant macular membranes and full-thickness macular holes: a retrospective study

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