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R. Scartozzi, O.P. Gupta, C.D. Regillo; Intraoperative Sclerotomy–Related Retinal Breaks for Macular Surgery, 20 versus 25 Gauge Vitrectomy Systems . Invest. Ophthalmol. Vis. Sci. 2006;47(13):4644.
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© ARVO (1962-2015); The Authors (2016-present)
To evaluate the incidence of sclerotomy–related retinal breaks(SRRBs) during 20 gauge pars plana vitrectomy (PPV) without trocar versus 25 gauge PPV with trocar for macular pucker (MP) and macular hole (MH).
Retrospective medical record review of 347 consecutive eyes undergoing PPV for MP or MH. Patients were excluded if they had any form of proliferative retinopathy, or if there was an intraoperative conversion of any sclerotomy from 25 to 20 gauge. Statistical comparisons were made using Fisher’s exact test.
219 eyes (63.1%) had 20 gauge PPV and 128 (36.9%) had 25 gauge PPV. 14 of 219 eyes (6.4%) of the 20 gauge group had intraoperative SRRB compared to 4 of 128 eyes (3.1%) of the 25 gauge group (p = 0.22). 5 eyes (2.3%) of the 20 gauge group had multiple SRRB, while none of the eyes in the 25 gauge group had multiple SRRB (p = 0.16). Of the 219 eyes in the 20 gauge group, 135 (61.6%) had the diagnosis of MP. Of the 128 eyes in the 25 gauge group, 84 (65.6%) had the diagnosis of MP. 7 eyes (5.2%) of the 20 gauge MP subgroup had intraoperative SRRB, compared to 1 eye (1.2%) of the 25 gauge MP subgroup (p = 0.16). 2 eyes (1.5%) of the 20 gauge MP subgroup had multiple SRRB, while none of the eyes in the 25 gauge MP subgroup had multiple SRRB (p = 0.53). Of the 219 eyes in the 20 gauge group, 84 (38.4%) had the diagnosis of idiopathic MH. Of the 128 eyes in the 25 gauge group, 44 (34.4%) had the diagnosis of MH. 7 eyes (8.3%) of the 20 gauge MH subgroup had intraoperative SRRB, compared to 3 eyes (6.8%) of the 25 gauge MH subgroup (p = 1.0). 3 eyes (3.6%) of the 20 gauge MH subgroup had multiple SRRB, while none of the eyes in the 25 gauge MH subgroup had multiple SRRB (p = 0.55). All identified intraoperative breaks were repaired successfully at the end of each case using endolaser. Among the 14 eyes which underwent 20 gauge PPV with intraoperative SRRB, 3 (21.4%) had postoperative sclerotomy–related rhegmatogenous retinal detachment within 2 months, with loss of best–corrected vision after subsequent repair. 2 of these 3 patients had multiple intraoperative SRRB, while 1 had a single SRRB. Among the 4 eyes which underwent 25 gauge PPV with intraoperative SRRB, none had postoperative sclerotomy–related retinal detachments.
Both approaches have a good safety profile with regard to intraoperative SRRB for macular surgery. There may be slightly lower rates of such breaks with the current 25 gauge approach, but a much larger series would be necessary to definitively demonstrate any statistical difference and, even if there was such a difference, it may not be of clinical significance, especially if the breaks are detected and managed properly.
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