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John Au, Alex Yuan, Jonathan Sears, Rishi Singh, Peter Kaiser; A Comparison of Surgical Outcomes After Diabetic Tractional Retinal Detachment Repair Using Small Versus Large Gauge Vitrectomy. Invest. Ophthalmol. Vis. Sci. 2012;53(14):362.
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© ARVO (1962-2015); The Authors (2016-present)
To compare surgical outcomes between traditional 20-gauge versus small (23 and 25) gauge vitrectomy surgery for diabetic tractional retinal detachment (TRD) repair.
We reviewed medical records of patients who underwent TRD repair by either large or small gauge vitrectomy between 11/2008 and 4/2011. To date, 27 consecutive patients who underwent large gauge and 28 consecutive patients who underwent small gauge vitrectomy with an ICD-9 code for TRD were included with 6 months of followup. Baseline characteristics such as age, prior glaucoma, prior laser treatment (PRP or focal), preoperative lens status and preoperative visual acuity (VA) were compared between each group. The primary outcome was change in VA and secondary outcomes included operative times, surgical complications, post operative lens status, postoperative complications including redetachments, and the choice of posterior segment tamponade (silicone oil VS gas). Numerical data was analyzed by student T-test. Categorical data was analyzed by Fisher Exact test.
Baseline characteristics between the two groups were well matched with no significant differences. The numbers of combination phacoemulsification/vitrectomy cases were similar between both groups: 15 small gauge cases and 14 large gauge cases were combined with cataract extraction (p=1.0). The average operative time was 90±8.4 minutes for small gauge surgery and 140.2±10.2 minutes for large gauge. This difference was statistically significant (p=0.0005). There was a trend favoring small gauge surgery for visual outcomes. The average net gain in vision was 37±9 letters for small gauge and 11±10 letters for large gauge (p=0.052). The baseline VA was comparable for both groups. The median baseline VA was 20/400 for small gauge and 20/1100 for large gauge (p=0.44). Median postoperative VA was 20/70 for small gauge and 20/200 for large gauge (p=0.01). There were no differences in rates of surgical and postoperative complications. There were 2 small gauge and 6 large gauge cases requiring reoperation (p=0.25). There was a statistically significant difference favoring the use of silicone oil in large gauge surgery (p=0.005). Oil was used in 9 of 27 large gauge cases and only 1 of 28 small gauge cases.
Though small in size, this preliminary study suggests that small gauge TRD repair is significantly faster while yielding similar or superior outcomes compared with traditional 20-gauge surgery.
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