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A. Angelilli, K. Wald, A. Athanikar, N. Radcliffe, J. Paccione, N. Gross; Post-Operative Intraocular Pressure in 20-Gauge verses 25-Gauge Vitrectomy for Macular Hole Repair. Invest. Ophthalmol. Vis. Sci. 2007;48(13):2223.
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To indirectly assess the integrity of sutureless 25-gauge incisions, we compared the post-operative intraocular pressure (IOP) of macular hole repair performed by 20 and 25-gauge vitrectomy surgery.
This retrospective study compared pre-operative and post-operative IOP as measured by Goldmann applanation tonometry in 100 sequential patients who underwent a standard vitrectomy for macular hole repair by one retina surgeon using sutured 20-gauge incisions (50 eyes) and 25-gauge sutureless incisions (50 eyes). With exception of the instrument gauge, the techniques were identical. All eyes were left with a 16% C3F8 gas fill. IOP measurements were recorded prior to surgery, post-operative day 1, week 1 and week 4.
Eighteen patients (36%) in the 20-gauge cohort and 20 patients (40%) in the 25-gauge cohort had a diagnosis of glaucoma or ocular hypertension prior to surgery. Average pre-operative IOP was 16.0 mmHg (20-gauge) and 15.3 mmHg (25-gauge). The difference in prevalence of glaucoma and pre-operative IOP was not statistically significant (p<0.01). The mean IOP on post-operative day 1 was 25.6 and 17.6, respectively. Increase in IOP on post-operative day 1 was 10.0 +/-8.6 (20-gauge) and 2.2+/-7.9 (25-gauge) and percent increase was 72.5% and 17.9%, respectively. Mean IOP at post-operative weeks 1 and 4 remained slightly elevated in the 20-gauge cohort (21.2 and 18.6) as compared to the 25-gauge cohort (17.6 and 15.2). Twenty-nine patients (58%) in the 20-gauge group and eight patients (16%) in the 25-gauge group required medical intervention for elevated IOP. The differences in IOP were all statistically significant with a one-tailed, equal variance t-test (p<0.001). Post-operative choroidal effusions, retinal detachment or endophthalmitis were not found in either group.
We found a clinically significant relative lowering of the post-operative IOP in eyes that underwent 25-gauge surgery compared to 20-gauge. The results are sustained to the 1 month postoperative examination. Sutureless 25-gauge sclerostomy incisions may be less competent than sutured incisions. For macular hole repair, there appears to be no adverse consequence.
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