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Fatma Dihowm, Mathew MacCumber; Comparison of outcomes between 20, 23 and 25 gauge vitrectomy for idiopathic macular hole. Invest. Ophthalmol. Vis. Sci. 2013;54(15):2806.
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© ARVO (1962-2015); The Authors (2016-present)
To compare the results of 20, 23, and 25 gauge vitrectomy with two different gas tamponades for idiopathic macular hole (MH) in a multi-surgeon vitreoretinal practice.
In this comparative, retrospective, interventional case series, the medical charts of 106 eyes/ 100 patients were reviewed. Patients who matched our inclusion criteria: eye with stage 2, 3, or 4 MH that underwent 20, 23, or 25 gauge vitrectomy, internal limiting membrane (ILM) peeling, and fluid-gas exchange from June, 2005 to October, 2011 and had at least 6 months follow up. The best corrected visual acuity and anatomical status of the MH were assessed by optical coherent tomography (OCT) at 6 months and 1 year after vitrectomy. Patients with myopia higher than 8D, epiretinal membrane, and previous retinal disease were excluded from the study. Results with perfluoropropane (C3F8) versus sulfur hexafluoride (SF6) were also examined.
The MH closed successfully after primary vitrectomy in 81.0% (20 gauge), 94.5% (23gauge), and 91.0% (25 gauge). Preoperative median visual acuities (VAs) were 20\100 (20 gauge), 20\150 (23 gauge), and 20\126 (25 gauge). At 6 months, postoperative VAs did not differ significantly between the 3 groups (P= 0.340). However, at 12 months postoperative median VAs were 20\50 (20 gauge), 20\115 (23 gauge), and 20\40 (25 gauge) and these differed significantly between the 3 groups (p=0.009). The results showed there was a statistically significant difference between the improvement in the 20 gauge or the 25 groups and the 23 gauge group (p value= 0.017 and p=0.006 respectively). Improvement in post-operative visual acuity in the 25 gauge and 20 gauge groups were not statistically different (p = 0.635). MH closed successfully at a higher rate with C3F8 (95.7%) than with SF6 (86.4%, p =0.052). Postoperative retinal detachment was 9.5% (20 gauge), 0% (23 gauge), and 2.2% (25 gauge).
MH surgery with 25-gauge or 20-gauge vitrectomy had better visual outcome than 23 gauge vitrectomy in this series, and MH surgery with C3F8 gas achieved better closure rate than MH surgery with SF6 gas. Further analysis as to the difference in outcome is ongoing.
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