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M. Manning, Jr., D. M. Marcus, J. Singh, H. Singh; 23-Gauge Vitrectomy: Visual Outcomes and Complications in 100 Eyes. Invest. Ophthalmol. Vis. Sci. 2007;48(13):2238.
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To report short-term outcomes & complications from the initial 100 eyes undergoing 23-gauge transconjuctival sutureless vitrectomy (23G PPV, Dutch Ophthalmics).
In this retrospective, consecutive case series 48 females & 52 males with an average age of 65 years (range 29-94 years) underwent 23G PPV by two surgeons (HS & DMM). Primary outcome variables including best corrected visual acuity & intraocular pressure were evaluated. Indications for vitrectomy included diabetic vitreous hemorrhage (27 eyes), retinal vein occlusion-related vitreous hemorrhage (4 eyes), vitreous hemorrhage secondary to other causes (7 eyes), diabetic tractional retinal detachment with or without vitreous hemorrhage (8 eyes), epiretinal membrane (23 eyes), diabetic macular edema (2 eyes), macular hole with or without epiretinal membrane (21 eyes), rhegmatogenous retinal detachment (2 eyes), and other causes (6 eyes). Silicone oil removal was performed in 4 eyes & injection in 1 eye. Forty four eyes were phakic & 56 eyes were pseudophakic. Fifty one patients were diabetic & 49 were non-diabetic. Average follow-up was 26 weeks (range 5 days - 62 weeks).
Average operating room (NOT operative) time was 28 minutes. No intraoperative complications were observed. Conversion to 20G PPV occurred in 1 eye during silicone oil removal.Mean preoperative visual acuity (VA) was 20/842 & mean postoperative VA was 20/429. Postoperative VA improved in 68%, worsened in 16% & remained unchanged in 16%.In those patients with poor preoperative VA of count fingers or worse, postoperative VA improved to 20/320 or better in 21 of 34 eyes (62%), worsened in 7 (20%) & remained unchanged in 6 (18%) eyes.In those patients with better preoperative VA of 20/500 or better, postoperative VA improved in 47 of 66 eyes (71%), worsened in 9 (14%) & remained unchanged in 10 (15%) eyes.Postoperative complications accounting for all cases of worsened VA: Retinal detachment (5 eyes), cataract progression (8 eyes), vitreous hemorrhage (2 eyes), absence of macular hole closure (2 of 21 eyes), new macular hole (2 eyes), phthisis (1 eye after silicone oil removal), posterior capsule opacification (1 eye).There were no clinical complications related to hypotony such as shallow chamber, choroidals, or corneal edema except one case of chemosis (though IOP remained >15mm Hg in that eye). One day post-op IOP was < 10mm Hg in 21 eyes and > 24mm Hg in 6 of 100 eyes.
23G PPV demonstrates comparable short-term visual outcomes & complication rates to that reported with 20- & 25-gauge systems with several distinct advantages over these systems.
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