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A. W. Zhou, K. J. Warrian, Y. Iordanous, M. Francispragasm, K. Chow, K. Gill, J. R. Gonder; Efficacy of 25-Gauge Surgery for Primary Repair of Rhegmatogenous Retinal Detachment. Invest. Ophthalmol. Vis. Sci. 2010;51(13):2557.
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To evaluate the efficacy and complication rate of sutureless, transconjunctival 25-gauge vitrectomy for primary repair of retinal detachment.
A retrospective chart review of a single surgeon’s practice was conducted to identify all patients receiving 25-gauge vitrectomy for primary repair of retinal detachment between January 2005 and December 2009. Past ocular history, perioperative and operative clinical parameters were collected. Re-detachment served as the primary outcome measure. Intraoperative and postoperative complications including wound leaks, suprachoroidal hemorrhage and endophthalmitis were secondary outcome measures. Binary logistic regression analysis was used to determine risk factors for re-detachment. The study was powered to detect an effect size of 0.3, with 80% power and an alpha of 0.05 with two-tailed analysis.
226 complete records were included. One hundred and thirty four (59.3%) had macular involvement and 83 (36.7%) patients were pseudophakic. Four patients (1.8%) had vitreous hemorrhage and 9 (4%) had proliferative vitreoretinopathy (PVR). Twenty two (9.7%) individuals had concurrent scleral buckling and 27 (11.9%) required intra-operative suturing of scleral ports for leakage. Three cases of combined cataract surgery (1.3%) and 6 (2.7%) cases of prior pneumatic retinopexy were noted. Thirty one (13.7%) individuals had prior laser/ cryo retinopexy and 18 (8%) had prior vitreoretinal surgery. Two patients (0.9%) had prior ocular trauma and one individual (0.4%) had a prior guarded filtration procedure. The rate of re-detachment was 5.3% (12). Mean follow-up 4.1 (+/- 7.3) months. There were no cases of supra-choroidal hemorrhage or endophthalmitis. Binary logistic regression analysis indicated that re-detachment was unrelated to phakic status, vitreous hemorrhage, PVR, scleral buckle, wound leak, combined cataract surgery, past history of pneumatic retinopexy, past history of laser/ cryo retinopexy, past vitreoretinal surgery, past ocular trauma or prior glaucoma surgery.
25-gauge surgery for repair of primary rhegmatogenous retinal detachment is as efficacious and has a similar published complication profile as a 20-gauge approach.
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