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M. T. Sandinha, C. F. de Souza, R. Essex, S. R. Lake, R. P. Phillips; Revisiting 25-Gauge Transconjunctival Sutureless Vitrectomy: Still Worthwhile?. Invest. Ophthalmol. Vis. Sci. 2008;49(13):5978. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
To report our surgical experience of 25-gauge transconjunctival sutureless vitrectomy (25G TSV) in a variety of vitreoretinal diseases.
This is a retrospective review of 175 eyes of 171 patients who underwent 25G TSV from January 2003 to August 2006 at Flinders Medical Centre, Adelaide, Australia. The patients studied had to have a follow-up of at least 3 months. Five different groups were evaluated: A) RRD: rhegmatogenous retinal detachment (n=62), B) IMH: idiopathic macular hole (n=42), C) ERM: epiretinal membrane (n=41), D) VH: diabetic vitreous haemorrhage (n=23) and E) TRD: tractional retinal detachment associated with proliferative diabetic retinopathy (n=7). The RRD cases were treated with 25G TSV only. Main outcome measures included surgical success, reoperation rate, final visual acuity (VA), final intraocular pressure (IOP) and intraoperative and postoperative surgical complications.
The overall mean follow-up was 10±8 months with a range of 3 months to 4.5 years. The mean overall VA was significantly improved (p<0.001) from 6/60 preoperatively to 6/18 at final follow-up. The improvement was highest in the diabetic group. Vitrectomy was combined with simultaneous phacoemulsification and intraocular lens insertion in: 9 eyes with RRD, 8 eyes with IMH, 12 with ERM and 10 with VH. Day 1 postoperative IOP ranged from 0 to 58mmHg and all cases but 13 (91.6%) returned to normal range at last review. Two cases of endophthalmitis (1.14%) happened earlier in the learning curve coinciding with subconjunctival (SC) antibiotics being discontinued in favour of topical treatment; no further cases happened since reverting to SC antibiotics. No intraoperative complications were noted.In group A, mean VA improved from 6/60 preoperatively to 6/18 postoperatively. Reattachment of the retina with a single operation was achieved in 53/62 RRD eyes (85.4%) whereas 9 (14.5%) required 2 or more operations. Redetachments occurred within the first 3 months. Two patients with ERM and one with IMH required subsequent retinal detachment surgery. Final anatomic success rate in all these cases was 100%.
25G TSV is safe and effective but has a significant surgical learning curve.
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