Abstract
Purpose: :
To describe outcomes and complications related to reoperation using the 23-gauge 3-port pars plana vitrectomy (23 G PPV) systemr.
Methods: :
This is a retrospective interventional consecutive case series of patients undergoing reoperation by one surgeon using the 23-gauge pars plana vitrectomy (23 G PPV) for a variety of retinal diseases. Patients were reoperated on between 9/07 and 11/09 with at least 1 month of follow up. The Alcon 1-step entry system and the Accurus vitrectomy machine were used in all cases. Data collection included demographics, surgical indications, operative procedures performed, intraoperative and postoperative complications especially related to sclerotomies, number of prior procedures, time period since last procedure.
Results: :
Twenty-three eyes of 23 patients satisfied the inclusion criteria, with a mean age of 60 years (range 32 - 78), 12 males and 11 females, with 11 phakic, 12 pseudophakic, and 3 aphakic. Three patients were operated on twice, making the total number of procedures 26. Indications included 3 full thickness macular holes, 8 proliferative diabetic retinopathy, 2 of those were non-clearing vitreous heme, 1 tractional macular detachment, 3 combined tractional rhegmatogenous detachment, and 2 with silicone oil (SO); 5 had epiretinal membranes, 2 diabetic macular edema, 1 cystoid macular edema, 6 rhegmatogenous detachment with proliferative vitreoretinopathy, and 1 central retinal vein occlusion with tractional macular detachment. Procedures Included membrane peel in 15 eyes, Internal limiting membrane peel in 7, endolaser in 13, relaxing retinotomy and retinectomy in 3, SO removal in 4, and injection in 3, expansile gas in 5 and non-expansile in 5, lensectomy in 1, and combined with temporary keratoprothesis and penetrating keratoplasty in 1. Prior procedures included three 23 G PPV, sixteen 20 G PPV, 2 patients with 2 prior 20 G PPV, 3 scleral buckles, and 2 unknown G PPV. Duration since the last procedure ranged from 1 to 40 months with a mean of 9 months. Two sclerotomies were planned 20 G and were sutured, and only 2 of 76 23 G sclerotomies needed a suture (2.6%). Intraoperative complications included 1 retinal break and 1 detachment. No eyes developed choroidals, or endophthalmitis.
Conclusions: :
Most ocular maneuvers can be accomplished with the 23 G PPV system in cases of reoperations. Integrity of the sclerotomies without leakage is maintained in most reoperations, irrespective of the duration since the prior PPV, the gauge of the prior PPV, the use of expansile or non-expansile gas or silicone oil. No major short term complications were observed.
Keywords: vitreoretinal surgery • vitreous • intraocular pressure