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M. R. Barakat, P. K. Kaiser; Outcome Comparison of 20 Gauge and 23 Gauge Vitrectomy. Invest. Ophthalmol. Vis. Sci. 2009;50(13):4210.
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© ARVO (1962-2015); The Authors (2016-present)
Microincision surgery is being employed with increasing frequency. Several series have reported on the outcomes of 20 gauge and 23 gauge surgery individually, but there have been no head-to-head comparison of the two techniques.
Prospective outcomes analysis of patients operated on at the Cole Eye Institute between January 1, 2006 and December 31, 2007 who met the following inclusion criteria: diagnosis of epiretinal membranes and/or posterior hyaloidal traction and who underwent either 23 or 20 gauge surgery. Cases with other or additional retinal diagnoses, such as retinal detachment or macular hole, were excluded. Early Treatment of Diabetic Retinopathy (ETDRS) protocol vision was performed pre-operatively, and at months 3 and 6 post-operatively. Additional data recorded included diabetic status, surgical factors, concomitant cataract extraction, the peeling of the internal limiting membrane (ILM). Statistical analysis, including paired t-test, one-way analysis of variance (ANOVA), and multivariate modeling for repeated measures, was completed using SPSS 14.0 (SPSS Inc., Chicago, IL).
Fifty-one patients were included in the study with 20-gauge and 23-gauge vitrectomy being performed on 25 and 26 patients, respectively. In the 20-gauge subgroup, 80% experienced improvement in VA, 11 letters by month 3 (p= 0.002) and 11.7 letters by month 6 (p= 0.001). In the 23-gauge subgroup, 77% had VA improvement, +5.5 letters at month 3 (p = 0.033) and +8.6 letters at month 6 (p = 0.002). Multivariate analysis of gauge type, surgical factors as mentioned above, and diabetic status yielded no statistically significant interactions. Unlike previous studies, the number of days to recovery of baseline visual acuity was equal for 20 gauge and 23 gauge surgery, at 33 and 32 days respectively. The maximum post-operative IOP increase for the 20-gauge group was 9.7 mm Hg compared to 5.3 mm Hg with 23-gauge surgery (p=0.022) with IOP lowering medication being prescribed in 48% versus 19.2% of patients, respectively. There was no statistical difference in post-operative decrease in IOP between groups. Non-IOP related complications included one case of retinal detachment, one case of cataract formation, and two cases of ptosis in the 20-gauge group, and two cases of vitreous hemorrhage, one case of optic nerve ischemia, and one extramacular hole in the 23 gauge group.
Visual outcomes and rate of visual recovery are similar in 20 and 23-gauge surgery. Elevated IOP is significantly more common in 20-gauge surgery.
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