23-gauge sutureless vitrectomy and 20-gauge vitrectomy: a case series comparison

Misra, A.; Ho-Yen, G.; Burton, R. L.
May 2009
Eye;May2009, Vol. 23 Issue 5, p1187
Academic Journal
PurposeTo directly compare the per-operative safety and efficacy of the 20- and 23-gauge vitrectomy systems as well as day 1 intraocular pressure (IOP).MethodsData were collected on 50 consecutive vitrectomy cases performed using the 20-gauge system and 23-gauge sutureless vitrectomy. All surgeries were carried out by one surgeon (RLB) at a single centre. Data collected prospectively included indication for surgery, iatrogenic retinal tears, and operating times.ResultsMost common indications for surgery were macular hole, rhegmatogenous retinal detachment, diabetic vitreous haemorrhage (no tractional retinal detachment), and macular pucker. Intraocular tamponade with air, sulphur hexafluoride (SF6), hexafluoroethane (C2F6) or octafluoropropane (C3F8), or silicone oil was used in 25 patients in the 20-gauge group and 46 patients in the 23-gauge group. One scleral port required suture in patients who underwent 23-gauge vitrectomy (0.67%). Every 20-gauge patient had all the three ports sutured. The mean first day IOP was 22.88 mm Hg in the 20-gauge vs 17.58 mm Hg in the 23-gauge (P<0.001). Four patients in the 20-gauge group had an IOP >40 mm Hg compared to none in the 23-gauge group. In contrast, four patients had postoperative hypotony in the 23-gauge group compared to none in the 20-gauge group. The mean operating time for all the 50 cases in each group was 39.4 (20 gauge) vs 29 min (23 gauge) P<0.001.ConclusionOur study indicates less risk of considerably raised IOPs and reduced surgical operating time with the 23-gauge system. Additional advantages observed included faster wound healing, diminished conjunctival scarring, improved patient comfort, and decreased postoperative inflammation.Eye (2009) 23, 1187–1191; doi:10.1038/eye.2008.175; published online 6 June 2008


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