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B. Wimpissinger, L. Kellner, U. Stolba, S. Binder; 20– versus 25– Gauge System for Pars Plana Vitrectomy: A Prospective Randomized Clinical Study . Invest. Ophthalmol. Vis. Sci. 2006;47(13):2689.
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Since the introduction of pars plana vitrectomy it has been the goal of researchers and clinicians to maximize efficiency of the used technologies and to minimize trauma and unwanted side effects. As a result modern 25 gauge systems for trans–conjunctival vitreoretinal surgery have recently become available. This miniaturisation has made sutures so far being necessary for scleral and conjunctival wound closure unnecessary. Several authors have emphasized the advantages of the 25 gauge system but so far no prospective randomized studies have been published.
We included 60 patients divided into two randomized groups. Indications for surgery were preretinal membrane, uncomplicated vitreous hemorrhage, synchisis scintillans, macular edema or macular hole. Cases requiring silicone oil or vitreoretinally preoperated patients were excluded. We examined the operating time divided into opening time, vitrectomy time, retinal manipulation time and closing time, the postoperative subjective pain and conjunctival injection, eye pressure, visual acuity, the retinal situation as well as intra– or postoperative complications before and up to three months after surgery.
The overall operating times were not significantly different (p=0.82) between the 20– and 25 gauge system. The vitrectomy time in the 25 gauge group was significantly longer (p<0.001). Opening and closing time were significantly shorter in the 25 gauge group (p<0.001, respectively). The patients` comfort and conjunctival injection during the first postoperative week were significantly better in the 25 gauge group (p<0.001, respectively). The surgeons` judgements of technical difficulties showed the necessity of an intra–operative switch from the 25– to the 20 gauge system in four cases due to insufficient light sources and too dense vitreous. Two postoperative retinal detachments (cured with additional surgery) and one transient vitreous haemorrhage occurred in the 20 gauge group.
The new sutureless 25 gauge system for pars plana vitrectomy offers a significantly improved postoperative comfort for the patients during the first postoperative week. The smaller surgical openings facilitate wound healing and minimize pain and discomfort. Operating times are the same, the shorter opening and closing time in the 25 gauge group are egalized by the longer vitrectomy time, if the same amount of vitreous is removed. Intraoperative manipulation as well as retinal manipulation and illumination are more difficult in the 25 gauge group. However, new technologies are needed and further research and development is necessary.
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