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T. Josifova, B. P. Henrich, U. Schneider; Results of 20-Gauge and 23-Gauge Vitrectomy Technique in Patients With Retinal Detachment and Proliferative Vitreoretinopathy. Invest. Ophthalmol. Vis. Sci. 2009;50(13):4193.
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The aim of this study was to compare the results of the silicone oil usage in 20 and 23-gauge pars plana vitrectomy (ppv) procedures in cases of complex retinal detachments (RD) with Proliferative Vitreoretinopathy (PVR).
We retrospectively evaluated the results of the ppv with silicon oil performed in 38 patients with the 20-g vitrectomy technique-Group A, and 26 patients with 23-g technique-Group B. The retinal tamponade was done with 5000 mPas silicone oil. Out of 64 eyes, 52 were pseudophakic, 9 were phakic and 3 eyes were aphakic.The average follow-up period was 5,6 months.
The rate of retinal reattachment in Group A after the initial surgery was 35/38, and in Group B in 23/26 eyes. In Group A during the exchange of perfluorocarbon liquids and silicon oil, while performing the drainage of the subretinal fluid, a presence of hypotony was seen in 2/38 patients, compared to Group B in 7/26 patients. Suturing of the sclerotomies in Group B was performed in 5/26 eyes. Entry side breaks in group A were seen in 2/38 eyes, while in Group B in 1/26 eyes. Postoperative hypotony (≥10 mmHg) in Group A was present in 3/38 eyes, while in Group B it was seen in 6/26 eyes. Presence of silicone oil under the conjuctiva was detected only in Group B in two cases.
The results between the patients operated with 20 and 23-g system did not show a big difference between the initial rate of success. The main problem in the 23-g ppv was the achieved hypotony during the prolonged time of different solutions exchange at the time of the operation, and leaking sclerotomies postoperatively. In cases with severe and very severe PVR retinal detachment, the 20-g ppv has advantages to 23-g ppv technique avoiding the intraoperative and postoperative hypotony. When performing the 23-g vitrectomy with silicone oil we suggest the suturing of the sclerotomies.
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