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P.L. Goodwin, R.M. Feist, J.O. Mason, III, M.F. White, M.L. Thomley, G. McGwin, Jr.; A Comparison of Visual Acuities, Complications and Operative Times Using 20–Gauge and 25–Gauge Vitrectomy Instruments for Idiopathic Epiretinal Membrane Removal . Invest. Ophthalmol. Vis. Sci. 2006;47(13):4649.
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To assess the effect of less invasive instruments on short–term post–operative visual acuities, complications and overall time in the operating room when performing vitrectomy for idiopathic epiretinal membrane removal using 25–gauge (25g) sutureless instruments versus the traditional 20–gauge (20g) system.
A retrospective chart review was performed on 178 consecutive patients receiving PPV for idiopathic ERM with 25g (n=102) and 20g (n=76) instruments by one of four vitreoretinal surgeons over the course of two years (6/2003–7/2005). Patients with evidence of active proliferative disease were excluded from the study. Patient demographics were comparable between the 25g and 20g groups respectively: age 70 vs. 67 years, males 44.34% vs. 52.78%, vitreomacular traction 16.98% vs. 25.0%, and diabetes mellitus 17.92% vs. 16.67%. Best corrected preoperative and postoperative visual acuities, intraocular pressures, intraoperative and postoperative complications, and start to finish operating times were collected from charts.
LogMAR best corrected visual acuities were equivalent preoperatively at 0.610 (20/81.5) for the 25g and 0.617 (20/82.8) for the 20g groups. There was no statistically significant difference in visual acuity found at 1 day, 1 week, 4 weeks, 2 months and 3 months between the two groups with both groups having equivalent visual acuities by the end of the study: 25g final BCVA 0.506 (20/64) and 20g 0.488 (20/61.5). There was a trend toward better visual acuity at 1 week in the 25g group (BCVA = 0.676 (20/94) vs. 0.787 (20/122) in the 20g group, p=0.057). For other outcomes evaluated there was a significant difference in the mean IOP at 1 day: 25g = 12.29 and 20g = 16.43, p=0.0001, the number of patients with IOP <10 at 1 day: 25g = 26 and 20g = 7, p=0.0175, and the number of intraoperative retinal tears: 25g = 1 and 20g = 7, p=0.0076. The operative time from open to close showed a statistically significant difference of approximately 19 minutes: 25g = 43.81 and 20g = 62.13, p=0.0005.
Our study suggests that 25g sutureless vitrectomy may be superior in terms of shorter operative times with a trend toward faster recovery of visual acuities at 1 week after surgery. Additionally, there were fewer intraoperative retinal tears requiring intraoperative laser in the 25–gauge group. Although our study is limited by being retrospective and having a short follow–up time, we suspect our results will be supported by more extensive studies.
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