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M. Giganti, G. J. Ko, D. M. Berinstein; 25-Gauge Vitrectomy for Retained Lens Fragments. Invest. Ophthalmol. Vis. Sci. 2008;49(13):5980.
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To compare outcomes and complications of pars plana lensectomy done with 25-gauge vitrectomy vs 20-gauge vitrectomy instrumentation.
Retrospective cohort study of 73 consecutive patients of a large, private retina subspecialty practice in Washington, DC, treated in 2006 for retained lens fragments, with either 25-gauge or 20-gauge vitrectomies. 25-gauge cases most often involved use of a 20-gauge fragmatome after enlarging one sclerotomy. All patients were referred by general ophthalmologists after cataract surgery. At least 2 post-operative visits at the retina practice were required for inclusion; patients were excluded for prior history of significant visual loss unrelated to cataract. The cases represent the work of 12 surgeons, and 6 of them had cases in both categories. Choice of 25-gauge vs 20-gauge was by surgeon’s preference. Data collected included age, interval from cataract extraction to PPV, visual acuity at presentation and after vitrectomy, and intra-operative or post-operative complications such as wound leaks, prolapsed tissue, hypotony, endophthalmitis, RD, and suprachoroidal hemorrhage. All Snellen VA were converted to a logMAR score before comparison; the T-test was applied, and P values calculated to compare subsets of patients treated with 25-gauge and 20-gauge PPV.
Average visual acuity at presentation was 20/400 for both 25-gauge and 20-gauge groups. Median interval from CE to PPV was 1 day and 2 days, respectively. Mean final visual acuity was 20/30 and 20/36, respectively. The difference was not statistically significant. No incidents of post-operative hypotony or endophthalmitis occurred. Two patients had choroidal hemorrhage noted intraoperatively, one from each group, with very poor outcome for the patient from the 25-gauge group. It was not possible to determine whether this complication was due to the vitrectomy or already existed at the time of PPV. Retinal breaks or RD were noted and treated intraoperatively in 4 patients; no patients developed new retinal breaks or RD after PPV. Two patients in each group developed CME; one in each group resolved quickly after STKI/IVKI administration.
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