25 Gauge Sutureless Vitrectomy and Standard 20 Gauge Pars Plana Vitrectomy in Idiopathic Epiretinal Membrane Surgery: A Comparative Study

Abstract

Abstract: : Purpose: To evaluate the safety and the functional outcome of a small incision, sutureless vitrectomy in the treatment of idiopathic epiretinal membranes (ERM) compared with a standard 20 gauge vitrectomy system. Methods: 46 consecutive eyes with idiopathic ERM were recruited for this study and prospectively evaluated. All patients were phakic. Mean age was 71 years (range 60–71 years). In group 1 (n=26) we used a transconjunctival sutureless 25 gauge vitrectomy system (TSV), group 2 (n=20) was operated on using a standard 20 gauge vitrectomy system. The ERM was removed and the internal limiting membrane was peeled in all eyes. Best corrected visual acuity (BCVA), operating time, intraoperative BSS consumption, surgery related complications, postoperative inflammation (score adapted from Barraquer), the patient’s postoperative discomfort (score adapted from Chalam) and cataract formation were assessed and compared. Follow–up was 6 months. Results: In group 1 preoperative BCVA ranged from 20/28.5 to 20/600 (median 20/150). Postoperative BCVA ranged from 20/20 to 20/200 (median 20/83.5) improving significantly (p<0.005, Wilcoxon test). In group 2 preoperative BCVA ranged from 20/28.5 to 20/200 (median 20/83.5). Postoperative BCVA ranged from 20/22 to 20/100 (median 20/67) improving significantly (p<0.01, Wilcoxon test). Operating time was significantly shorter in group 1 (15.6 min, SD 2.2) compared with group 2 (40.6 min, SD 4.9). Mean BSS consumption was in group 1 28 ml (range 20–35 ml) and in group 2 35 ml (range 20–45 ml), not statistically different. Postoperative inflammation score after 1 day in group 1 was: 1.9 (range 1–3), and in group 2 was 3.0 (range 2–4) (p<0.05); after 1 week was 1.0 (range 0–2) in group 1 and 2.0 (range 1–3) in group 2 (p<0.01). The patient’s postoperative discomfort score after 1 week was in group 1: 1.9 (range 0–3) and in group 2 4.2 (range 1–6), significantly different (p<0.01, Mann–Whitney test). No intra or postoperative complications were observed in group 1. In group 2 cataract formation was seen in 2 eyes. Postoperative intraocular pressure did not vary significantly from the preoperative value, in particular no postoperative hypotony was observed. Conclusions: BCVA improved significantly in both groups, but operating time is significantly reduced, minimizing the surgery induced trauma and hastening the rehabilitation in group 1. Therefore TSV is a safe and efficient surgical technique for ERM surgery.

Keywords: macula/fovea • vitreoretinal surgery