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T. M. Newman, R. Wetzel, W. May, K. Crowder, C. J. Chen; Early Outcomes of 23 Gauge Transconjunctival Sutureless Vitrectomy. Invest. Ophthalmol. Vis. Sci. 2007;48(13):2239.
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To report early outcomes in eyes undergoing 23 gauge transconjunctival sutureless vitrectomy (TSV) .
Chart review of the initial 56 patients (56 eyes) that underwent TSV by one surgeon (CJC). Surgical indications included: macular hole (n=16), epiretinal membrane (n=14), diabetic vitreous hemorrhage (n=12), retinal detachment (n=8), and other (n=8). Of the 56 patients, 43 had at least 2 month follow up. The longest follow up was 6 months. Main outcome measures included visual acuity, intraocular pressure, intraoperative complications, patient comfort level, conjunctival appearance, evidence of wound leak.
Overall visual acuity for all groups was 20/332 preoperatively and 20/112 postoperatively (p<0.001). The diabetic vitreous hemorrhage group showed the largest and most statistically significant improvement in visual acuity, while the epiretinal membrane group showed the least significant change. The mean preoperative intraocular pressure (IOP) in mmHg was 16.1 + 4.55. IOP was adjusted to within a range of 9-12 mmHg at the end of each operation. At 2 hrs postoperatively, IOP was elevated in 4 of 56 eyes, requiring treatment with topical glaucoma drops. 3 of 56 eyes were hypotonous (≤5mmHg) and were observed. All 3 hypotonous eyes had IOP ≥ 10mmHg the following morning. The lowest recorded IOP on postoperative day 1 was 8 mmHG. IOP was elevated in 5 eyes on postoperative day1, requiring treatment. There were 3 cases of intraoperative iatrogenic retinal tear (5.4%). There were a total of 4 sclerotomy site leaks in 4 eyes at surgery, 2 of which required scleral suturing. 3 of the 4 leaks occurred in eyes with prior 20 gauge vitrectomy. There was no conjunctival bleb or sign of sclerotomy leak noted in any eye at 1 week. There was no hyperemic conjunctival reaction in any eye at 1 week. 5 eyes had some degree of subconjunctival hemorrhage at 1 week. 8 patients reported mild eye pain or discomfort.
The new 23 gauge vitrectomy technique and instrumentarium appear to be well suited to a wide range of vitreoretinal surgical indications. Early results seem to demonstrate an acceptably low rate of surgical complications including: iatrogenic retinal tears, wound leaks, and intraocular pressure abnormalities. Patient comfort, appearance, and anterior segment reaction seem to be improved with this technique over conventional vitrectomy, though no direct comparisons were made in this study. More patients, longer follow up of existing patients, and direct comparison with conventional vitrectomy will further help to define the role for this technique in surgical practice.
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