Abstract
Purpose::
Recent developments in vitreous surgery have led to the introduction of 25-gauge (25G) transconjunctival sutureless vitrectomy as an alternative to the conventional 20-gauge systems. Although facilitating the rehabilitation of patients by increased post-surgical patient comfort certain limitations have to be considered and increased complication rates have been reported. Aim of this retrospective case series was to evaluate the transition period from 20G to 25G vitrectomy in a clinical routine seeting.
Methods::
A total of 265 consecutive vitrectomies performed by the same surgeon covering a period before the introduction of 25G, the transition period to 25G vitrectomy and a period of routine use of 25G vitrectomy were retrospectively evaluated with respect to indications, parameters of the surgical procedure, intra- and post-surgical complications and surgical outcome. The follow-up period was 1 year.
Results::
Over the observation period of one year 140 20G and 125 25G vitrectomies were performed. After a transition period of three months 95% of all vitrectomies covering all indications, besides foreign body removal and dropped nucleus were performed using 25G. The overall operating time could be reduced from a mean of 63,3±28,5 minutes in the 20G to 41,4±18,4 minutes in the 25G group. Postsurgical patient comfort was markedly improved. There were no intrasurgical complications reported and only 2 eyes with 25G vitrectomy needed suturing of the sclerotomies. Hypotony at the first post-surgical day was observed in 10% of the 25G procedures and 1.5% of the 20G procedures. No choroidal detachments occurred. In both groups, including all eyes with rhegmatogenous retinal detachment as a primary surgical indication, three cases with retinal detachment between the 10th and 129th post-surgical day were observed. No endophthalmitis was seen.
Conclusions::
These results demonstrate that 25G vitrectomy can be used as a routine surgical technique in more than 90% of cases (indications). Performed by an experienced surgeon it provides a marked reduction of operating time and improved patients comfort. However, due to the flexibility of the instruments and necessary adaptations to the surgical technique a learning curve has to be considered even for experienced surgeons.
Keywords: vitreoretinal surgery