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Yasushi Ikuno, Tomoko Asai, Shinsaku Yano, Kohji Nishida; Effects Of Small-gauge Vitrectomy Systems On Surgical Time, Safety, And Efficacy Of Myopic Macular Surgery. Invest. Ophthalmol. Vis. Sci. 2012;53(14):3761.
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Since the small gauge vitrectomy has become safer, its indication is expanding in many vitreoretinal diseases. Vitrectomy in highly myopic eyes has a challenging aspect because thinner sclera and greater volume of vitreous cavity hinder the self-sealing. This retrospective study has been conducted in order to explore the effect of small-gauge vitrectomy for high myopia-specific complications.
We investigated patients who underwent 3-port vitrectomy with various gauges for myopic macular diseases including myopic foveoschisis, macular hole with or without retinal detachment. The numbers of patients are as follows: the 20-gauge [G] system, 33 eyes; no-suture 23 G, 20 eyes; sutured 23 G, 20 eyes; and 25 G, 11 eyes. All the scleral ports and conjunctiva were sutured in 20 G and no suture was placed in 23 G? and 25 G. All the surgeries included vitrectomy and vitreous cortex separation from the retina with triamcinolone acetonide, internal limiting membrane peeling, and gas tamponade. The information of patient history, ophthalmologic data, and surgical times were collected and compared.
Mean surgical times were 64 min for 20 G; 47 min, no-suture 23 G; 46 min, sutured 23 G; and 40 min, 25 G (P<0.0001 by one-way ANOVA). The mean 3-month logMAR visual acuities were 0.92 for 20 G; 0.74, no-suture 23 G; 0.51, sutured 23 G, and 0.49, 25 G (P<0.05 by one-way ANOVA). Mean postoperative corneal astigmatism was higher with 20 G (-1.81 diopters [D]) than the others (-1.14, -1.25, and -1.18 D, P=0.08 by one-way ANOVA). Mean intraocular pressures at 1 day were 15.6 mmHg for 20 G; 11.9 mmHg, no-suture 23 G; 19.4 mmHg, sutured 23 G; and 14.6 mmHg, 25 G; (P<0.05 by one-way ANOVA).
Small-gauge system shortens the surgical time, and enables quicker visual function recovery. In terms of avoiding gas escape and involuntary hypotension, sutured 23G or 25G system seems to be more favorable. All small gauge systems were comparable to the standard 20 G system in its safety and efficacy.
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