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M. Albrieux, F. Rouberol, K. Palombi, J.-P. Romanet, C. Chiquet; Comparative Study of 23-Gauge Transconjunctival Sutureless Vitrectomy (versus 20-Gauge) for Primary Rhegmatogenous Retinal Detachment Surgery. Invest. Ophthalmol. Vis. Sci. 2010;51(13):6057.
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To compare the per-operative safety and efficacy of the 20 and 23-gauge pars plana vitrectomy (PPV) for management of primary rhegmatogenous retinal detachment (RD).
This prospective study included 35 consecutive 23-gauge transconjunctival vitrectomy cases matched with 35 20-gauge cases, for the following preoperative factors: best corrected visual acuity, axial length, lens and macular status, the location and number of breaks in attached or detached retina, PVR grade, and duration of visual acuity loss. All patients benefitted from complete PPV, cryotherapy and fluid-gas exchange. End points were the primary reattachment rate, the anatomical success rate, the functional prognosis and complications.
Most patients were pseudophakic (77.1%). RD were associated with 2.69 ± 2.21 retinal tears, macula was attached in 37% of the cases and proliferation vitreoretinopathy was classified as grade B or lower in all cases. All patients had a minimum postoperative follow-up of six months. Mean operative time (70.58 ± 21.90) and per operative complications rate (15%) were similar in both groups. Single reattachment rate was 74.2% in the 20G group and 82.8% in the 23G group. The final anatomical success rate was 97% in the two groups. Mean preoperative visual acuity of 1.17 ± 0.9 logMAR improved similarly in both groups to 0.36± 0.4 at the last visit. 61.4% of eyes had final vision of 20/40 or better. Scleral or conjunctival sutures were needed in 5% and 51% of the cases in the 23G group, respectively. One patient had intraocular pressure of 8 mmHg at day 1 in this group. Choroidal detachment or endophthalmitis were not observed in any patient.
23G PPV is as safe, reproducible and efficient than the 20G technique for the management of non complicated rhegmatogenous RD. Potential advantages of the 23G technique include less postoperative pain and discomfort.
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