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T. Harper, R. Oliveira, J. Kitchens, D. Miller, H. Flynn, Jr.; 25–Gauge Transconjunctival Vitrectomy at a University Teaching Institution: Indications, Complications, and Visual Outcomes . Invest. Ophthalmol. Vis. Sci. 2006;47(13):4647.
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© ARVO (1962-2015); The Authors (2016-present)
To evaluate the indications, complications, and visual outcomes of 25–gauge sutureless vitrectomy at a university teaching institution.
Single–center, retrospective, noncomparative case review of 81 eyes undergoing 25–gauge vitrectomy at the Bascom Palmer Eye Institute from January 2004 through November 2005.
The indications for 25–gauge vitrectomy included diabetic retinopathy (37%), epiretinal membrane (24.7%), macular hole (21%), vitreous hemorrhage not caused by diabetic retinopathy (4.9%), retinal detachment (3.7%), vitreous opacities (3.7%), and miscellaneous (5%). The average follow–up period was 12 weeks. Complications included recurrent or persistent epiretinal membrane (8.6%), recurrent vitreous hemorrhage (4.9%), recurrent retinal detachment (1.2%), and proliferative vitreoretinopathy with hypotony (1.2%). No postoperative filtering conjunctival blebs were noted. Only one of the cases in this series was converted to conventional 20–gauge vitrectomy. Hypotony on postoperative day 1 (IOP of ≤ 5) occurred in 3 eyes (3.7%). The hypotony in these cases resolved without surgical intervention. Because of a concern for sclerotomy leakage, sutures were placed into one or more sclerotomy sites at the end of surgery in 8 eyes (9.9%). Postoperative visual acuities of ≥ 20/400 and ≥ 20/40, respectively, were obtained in: 23 of 29 (79.3%) and 11 of 29 (38%) eyes undergoing vitrectomy for diabetic retinopathy; 16 of 17 (94.1%) and 6 of 17 (35.3%) eyes undergoing vitrectomy for idiopathic macular hole; and 17 of 19 (89.5%) and 3 of 19 (15.8%) eyes undergoing vitrectomy for epiretinal membrane. In the subset of patients undergoing vitrectomy for macular hole, 13 of 17 eyes (76.5%) achieved anatomic closure. Concurrent phacoemulsification with intraocular lens placement was performed in 11.1% of cases.
25–gauge transconjunctival vitrectomy is an acceptable alternative to conventional 20–gauge vitrectomy for many types of vitreoretinal pathology. Patients in this series experienced less postoperative pain and shorter recovery times, while visual outcomes and complications were similar to those obtained with 20–gauge vitrectomy at our institution.
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