Abstract
Abstract: :
Purpose: To determine the relative benefits of membrane delamination for post vitrectomy epiretinal membranes using either a standard 20 gauge vitrectomy system or a sutureless 25 gauge system. Methods: Retrospective analysis of 42 patient charts who underwent vitrectomy surgery, and subsequently developed postoperative macular puckering. Primary endpoint investigated is the final postoperative snellen visual acuity. Results: Patients underwent initial vitrectomy surgery for a variety of pathologies that included rhegmatogenous retinal detachment (n = 27), proliferative diabetic retinopathy (n = 5), epiretinal membrane (n = 4), traumatic retinal detachment with IOFB (n = 3), central retinal vein occlusion (n = 2), and chronic endophthalmitis (n = 1). The 20 and 25 gauge vitrectomy systems were used for 24 and 18 eyes, respectively. Average follow up time was 9 months for the 20 gauge group, and 5 months for the 25 gauge group. Initial visual acuity was better in patients that ultimately underwent a 25 gauge vitrectomy for their final procedure, 20/325 vs. 20/950. However, there was not a large difference in the visual acuity after development of postoperative macular pucker, and prior to the final vitrectomy where the different vitrectomy systems were used. Average vision prior to membrane peeling with the 20 or 25 gauge systems was 20/760, and 20/610 respectively. Average final postoperative visual acuity was not improved after use of the 20 gauge system and was measured at 20/795. Vision was stabilized after this intervention in 16 out of 24 patients; 1 patient underwent a 3 line vision loss; and 1 patient lost 2 lines of visual acuity. Five patients improved by 3 or more lines with respect to the final vision, and 2 eyes improved by 2 lines. In contrast, the average final visual acuity after use of the 25 gauge system was overall improved at 20/300. No patients lost more than 1 line of vision following this procedure, while 10 out of 18 patients had stable visual acuity within 1 line of the preoperative measurement. A substantial number of patients had remarkable visual improvement; 2 patients with 2 lines of improvement, and 6 with an improvement of 3 lines or greater. Conclusions: The outcomes of vitrectomy surgery for a postvitrectomy macular pucker appear better following 25 gauge vitrectomy surgery compared to the 20 gauge standard approach. Overall, patients had a higher chance of vision improvement, and a lower risk of vision loss following 25 gauge vitrectomy.
Keywords: vitreoretinal surgery • retinal detachment • retinal glia