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Renaud Duval, John Pollack, Joseph Civantos, Kirk Packo; The influence of vitrectomy machine fluidics on the rate of iatrogenic retinal breaks in primary small-gauge vitrectomies. Invest. Ophthalmol. Vis. Sci. 2013;54(15):3327. doi: https://doi.org/.
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To evaluate whether the fluidics of the vitrectomy machine affect the rate of iatrogenic retinal breaks in primary small-gauge vitrectomy.
Retrospective chart review of patients that underwent primary 23-gauge and 25-gauge transconjunctival vitrectomies between October 2004 and July 2012. Exclusion criteria were any prior history of retinal surgery, retinal tears or retinal detachment, less than 3 months of follow-up, and current surgery for retinal detachment. The surgery was either performed on the Alcon Accurus (2500-1500cpm, max vac 230mmHg) or on the Alcon Constellation (5000cpm, max vac 475 mmHg). Rates of intraoperative retinal breaks and retinal detachments were obtained from the operative reports and postoperative events were taken from the chart notes.
134 eyes of 126 patients were included in the analysis; the surgery was performed on the Alcon Accurus in 91 eyes and on the Alcon Constellation in 43 eyes.There was no statistical difference between the groups in terms of average age, gender, laterality, lens status, PVD induction or gauge of the surgical instruments. The difference in the distribution of surgical indications between the groups was significantly different (p=0.0034), with the Accurus group having more vitreomacular traction cases (7.7% vs 0%) and the Constellation group having more vitreous opacity cases (11.6% vs 2.2%). Preoperative visual acuities were 20/100 in the Accurus group versus 20/70 in the Constellation group while final visual acuities of 20/70 and 20/60 were obtained respectively for the Accurus and Constellation machines. These differences were statistically significant only for preoperative visual acuities (p=0.004). Intraoperative retinal breaks were present in 17.6% in the Accurus group versus 9.3% in the Constellation group (p=0.300). One intraoperative retinal detachment occurred in the Accurus group and none in the Constellation group (p=1.00). No postoperative retinal breaks or retinal detachments were noted in either group. Univariate and multivariate analyses did not find any factor to be significantly associated to the rate of retinal breaks in this study.
Despite a small trend towards a lower rate of iatrogenic retinal breaks with the Constellation vitrectomy machine, there was no statistically detectable effect of the machine fluidics on this surgical complication.
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