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Nirali Bhatt, Gayatri Reilly, Raymond N. Sjaarda, John T. Thompson; Complications of Standard and Small Gauge Pars Plana Vitrectomy. Invest. Ophthalmol. Vis. Sci. 2012;53(14):2593.
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This study compared complications of standard (20-gauge) to small gauge (23- or 25-gauge) pars plana vitrectomy.
A retrospective, consecutive case series of 608 eyes with 20-gauge (n=300, 49.3%) or 23-/25-gauge vitrectomy [n=308 (194, 114), 50.6% (63%, 37%)] performed by the same two vitreoretinal surgeons for epiretinal membrane (ERM), macular hole (MH), non-clearing vitreous hemorrhage (VH), vitreous opacity, retinal detachment (RD), retained lens fragments, lens dislocation, and vitreomacular traction. Patients were observed postoperatively for a minimum of 60 days. The main outcome measures were intraocular pressure (IOP), intraoperative and postoperative complications.
The mean preoperative IOP (mmHg) in the 20-gauge group was 15.5, post-operative day 1 IOP was 18.6, week 1 IOP was 17.9, week 6 IOP was 15.6, and month 3 IOP was 14. Mean preoperative IOP in the 23- or 25-gauge group was 15, post-operative day 1 IOP was 14, week 1 IOP was 17, week 6 IOP was 15 and month 3 IOP was 14, Complications common to both groups included: VH (n=19, 6.33% for 20-gauge vs. n=19, 6.2% for 23-/25-gauge), new or recurrent RD (n=18, 6% vs. n=11, 3.5%), persistent MH (n=7, 2.33% vs. n=4, 1.3%), retinal tear (n=2, 0.67% vs. n=1, 0.32%) and hypotony (n=1, 0.33% vs. n=9, 2.9%). The increased risk of 1-day post-operative hypotony (IOP ≤ 5) in the small gauge subgroup was statistically significant (p<0.02) but was not statistically significant at 1 week (p<0.24). Complications found primarily in the 20-gauge group included persistent CME (n=15), recurrent ERM (n=7), subretinal hemorrhage (n=1), corneal edema (n=1), and angle closure glaucoma (n=1). The increased incidence of post-operative CME in standard versus small gauge vitrectomy was found to be statistically significant (p<0.0001). Complications found primarily in the 23-25-gauge group included choroidal detachment (n=3), endophthalmitis (n=2), and intraoperative dislocation of the infusion cannula (n=1).
Small gauge vitrectomy has an increased risk of complications not traditionally found with standard 20-gauge surgeries, including hypotony, choroidal detachment and dislocation of the infusion cannula while standard gauge vitrectomy has an increased risk of CME. The incidences of other complications were similar between the two groups.
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