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E. K. Chin, D. F. Kiernan, S. M. Hariprasad, R. Singh, W. F. Mieler; Superior Surgical Outcomes of 25- Over 20-Gauge Transconjunctival Vitrectomy Combined With Cataract Surgery for Vitreoretinal Diseases. Invest. Ophthalmol. Vis. Sci. 2008;49(13):4699.
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To compare surgical outcomes of 20- versus 25-gauge transconjunctival vitrectomy combined with cataract surgery for the management of vitreoretinal diseases and significant cataract.
A retrospective, interventional case study was conducted. Chart review of a consecutive series of 22 eyes of 22 patients who underwent either 20- or 25-gauge vitrectomy combined with phacoemulsification and intraocular lens implantation for epiretinal membrane (n = 12), idiopathic macular hole (n = 2), non-clearing vitreous hemorrhage (n = 3) or tractional retinal detachment associated with proliferative diabetic retinopathy (n = 5). Main outcome measures included pre- and postoperative visual acuity (VA), intraocular pressure (IOP) and intra- and postoperative complications. Statistical analysis was performed using a two-tailed Student’s t-test.
The mean follow-up period was 10.9 months (range, 6 to 30). The mean overall LogMAR VA improved from 0.8066 preoperatively to 0.4062 at final visit (P = 0.09). Subgroup analysis demonstrated no statistically significant improvement of VA in the 20-gauge group (0.5601 to 0.5515, P = 0.63), but statistically significant improvement in the 25-gauge group (0.8066 to 0.4062, P = 0.003). In the 20-gauge group, there was one intraoperative complication of a dropped nucleus and one post-operative case of endophthalmitis. In the 25-gauge group, there were no intra- or post-operative complications; no cases required suture placement to sclerotomy sites and no cases required conversion to 20-gauge standard instrumentation. Postoperative intraocular pressure remained stable in most cases except in the 20-gauge group which had 3 eyes with increased pressure and 1 eye with hypotony during the first week after surgery.
Despite having worse preoperative visual acuity, 25-gauge vitrectomy combined with cataract surgery demonstrates superior visual acuity outcomes and fewer intra- and post-operative complications compared with 20-gauge surgery. A prospective, randomized, large series trial is recommended to precisely evaluate the surgical outcomes of 25- and 20-gauge vitrectomy.
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