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L. M. Kellner, B. Wimpissinger, U. Stolba, K. Krepler, W. Brannath, S. Binder; 20- versus 23- Gauge System for Pars Plana Vitrectomy: A Prospective Randomized Clinical Study. Invest. Ophthalmol. Vis. Sci. 2007;48(13):6029.
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To compare the 23-gauge system for sutureless pars plana vitrectomy (23g) to a standard 20-gauge system (20g) in a prospective randomized clinical study.
60 patients in 2 randomized groups were included. Indications for surgery were preretinal membrane, vitreous hemorrhage, retinal detachment, diabetic retinopathy, synchisis scintillans, macular edema and macular hole. Patients with previous vitreous or retinal surgery were excluded.The parameters examined were postoperative subjective pain and conjunctival injection, time for surgery divided into opening, vitrectomy, retinal manipulation and closure time, eye pressure, visual acuity, retinal condition and intra- or postoperative complications before and 1,2,3, days and 1 and 3 months post surgery. For statistics Student`s t-test was used.
Patients` comfort was significantly higher in the 23g group (p<0.02), the conjunctival injection significantly lower (p<0.02) during the first three postoperative days.Total surgery time was almost equal (p=0.93) but unequally distributed. Vitrectomy in the 23g group took significantly longer (p<0.032). Wound closure was significantly shorter in the 23g group (p<0.0001). More cases showed postoperative hypotony in the 23g group (n=6) than in the 20g group (n=2) (n.s.). Vitreous and retinal instruments showed sufficient stability but trocars and plugs caused difficulties during 23g surgery (n=5). No technical difficulties occurred in the 20g group. Suturing of sclerotomies and conjunctiva was necessary (n=4) in the 23g group. More severe postoperative complications occured in the 23g group (n=5)(1 eye lost due to massive choroidal hemorrhage) than in the 20g group (n=3).
The 23g system for pars plana vitrectomy offers significantly higher comfort to the patients during the first 3 postoperative days. Smaller surgical openings facilitated wound healing and minimized pain and discomfort. Time for surgery was almost equal, the shorter time for wound closure in the 23g group being equalized by the longer vitrectomy time, if the same amount of vitreous was removed. Intra- and postoperative complications were more severe unrelated to the underlying disease in the 23g group.
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