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A. Tewari, G. K. Shah, A. Fang, M. S. Dhalla; Visual Outcomes With 23-Gauge Transconjunctival Sutureless Vitrectomy. Invest. Ophthalmol. Vis. Sci. 2007;48(13):2219.
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To evaluate the outcomes of patients treated with 23-gauge transconjunctival sutureless vitrectomy for various posterior segment conditions.
Retrospective review of 81 consecutive 23-gauge vitrectomy cases done by a single vitreoretinal surgeon at the Barnes Retina Institute. All surgery was performed using the 23-gauge system developed by Dutch Ophthalmic Research Corporation (DORC). Patients with less than 3 months follow-up were excluded. Indication for surgery, preoperative visual acuity and lens status were among the factors recorded. Intraocular pressure, best corrected visual acuity at most recent follow-up visit and any interventions done in the post-operative period, including reoperations and cataract extraction, were noted.
Indications for surgery included epiretinal membrane (20 eyes), macular hole (16 eyes), diabetic macular edema (16 eyes), non-clearing vitreous hemorrhage (10 eyes), tractional retinal detachment (7 eyes), vitreomacular traction (5 eyes), rhegmatogenous retinal detachment (5 eyes), and submacular hemorrhage (2 eyes). Lens status was phakic (48 eyes), pseudophakic (31 eyes), and aphakic (3 eyes). Mean follow-up was 5.5 months. Mean intraocular pressure on post-operative day one was 14 mmHg (range 6-28). Mean preoperative visual acuity was 20/150 (range 20/30 to hand motion) and mean postoperative visual acuity was 20/70 (range 20/20 to hand motion). No case required conversion to 20-gauge vitrectomy. Three eyes (3.7%) required suturing of sclerotomy sites due to suspected wound leakage. There was a single case (1.2%) of intraoperative retinal tear that required treatment with cryotherapy. There was no postoperative retinal detachment or endophthalmitis. A single case of postoperative vitreous hemorrhage was noted in a patient who had underwent a primary diabetic vitrectomy. Seven patients (8.6%) had worsening of cataracts in the post-operative period but no patient had cataract surgery done in that time.
23-gauge transconjunctival sutureless vitrectomy is an effective surgical technique in the management of vitreoretinal diseases. Complications were rare and compared favorably with published literature on 20-gauge surgery.
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