25–Gauge Transconjunctival Vitrectomy: Intraoperative Safety

Abstract

Abstract: : Purpose: To evaluate the intraoperative safety of 25–gauge transconjunctival vitreoretinal surgery. Methods: A consecutive series of 209 eyes in 200 patients that underwent 25–gauge vitrectomy between April 2002 and October 2003 were followed prospectively. The main outcome variable was the occurrence of an intraoperative complication, defined as any adverse event that occurred or was discovered at the time of surgery including retinal tears, retinal detachment, and cataract requiring lensectomy. Conversion to 20–gauge vitrectomy or need for conjunctival or scleral sutures was considered an adverse event for this study. Results: Sixteen of 209 (7.7%) eyes had an intraoperative complication as defined above. The complications included unplanned conversion to 20–gauge vitrectomy in 7/209 (3.3%), one or more retinal tears without retinal detachment in 5/209 (2.4%), retinal tear with associated retinal detachment in 1/209 (0.5%), crystalline lens damage in 1/209 (0.5%), and closure requiring sutures in 2/209 (1%). All intraoperative complications were recognized at the time of surgery and successfully treated. One complication, the retinal detachment, was deemed a serious adverse event. Of the seven cases converted to 20–gauge vitrectomy, the preoperative diagnoses consisted of vitreous hemorrhage (3), retinal detachment (3), macular hole (1), macular pucker (1), and fungal endophthalmitis with retinal detachment (1). The reasons for conversion included infusion of silicone oil (4), instrumentation issues (4), and surgeon’s preference (3). In four of seven cases, three ports were converted. In two of seven cases, one port was converted, and in one of seven cases, two ports were converted. Conclusions: The rate of intra–operative complications using the 25–gauge vitrectomy is low. While this study lacks a prospective control group, intra–operative complication rates with 25–gauge vitrectomy seem comparable to rates with 20–gauge vitrectomy.

Keywords: vitreoretinal surgery • clinical (human) or epidemiologic studies: outcomes/complications • retina