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A. B. Theventhiran, S. J. Garg; Incidence of Retained Subretinal Perfluorocarbon Liquid in 23-Gauge Sutureless and 20-Gauge Sutured Vitrectomy for Retinal Detachment Repair. Invest. Ophthalmol. Vis. Sci. 2009;50(13):4206.
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© ARVO (1962-2015); The Authors (2016-present)
Sutureless pars plana vitrectomy (PPVx) has a number of advantages, including quicker operative times and greater patient comfort postoperatively. Recently, there have been reports about increased complications with sutureless vitrectomy, including an increased incidence of endophthalmitis. The purpose of this study is to assess the rate of retained subretinal perfluorocarbon liquid (PFCL) in patients undergoing rhegmatogenous retinal detachment repair with 23-gauge sutureless vitrectomy versus those with sutured 20-gauge vitrectomy.
A retrospective, interventional, comparative cohort study. All patients with a diagnosis of rhegmatogenous retinal detachment that underwent PPVx for retinal detachment repair from 11/1/05 through 10/31/08 were included. One of the authors (SG) was the attending surgeon for all cases.
A total of 234 retinal detachment repairs were performed during the study period. Subretinal PFCL occurred in 3 of 176 eyes (1.7%) that underwent 20-gauge sutured PPVx and in 6 of 58 eyes (10.3%) that underwent sutureless PPVx for repair of retinal detachment (p=0.008, Fisher exact test).In the 20-gauge PPVx group, subretinal PFCL was found in 2/63 eyes with proliferative vitreoretinopathy (PVR) and in 1/113 eyes with no PVR. In the sutureless repair group, subretinal PFCL was present in 3/19 eyes with PVR and in 3/39 patients without PVR.
There is a statistically significant 6-fold increased incidence of retained subretinal PFCL in patients undergoing retinal detachment repair with 23-gauge sutureless vitrectomy versus 20-gauge sutured vitrectomy. This is likely due to higher fluid flow through open 23-gauge sclerotomies compared to 20-gauge sclerotomies. This allows the infusion to disrupt the surface tension of the PFCL resulting in formation of numerous small PFCL bubbles that can then enter the subretinal space. Clinicians should reduce flow during sutureless vitrectomy to prevent this potential complication.
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