Evaluation of 25-gauge Transconjunctival Standard Vitrectomy (TSV) on Previously Non-operated Eyes

Abstract

Abstract: : Purpose: To evaluate 25-gauge Transconjunctival Standard Vitrectomy (25-G TSV) for vitreoretinal procedures on non-operated eyes. Methods: Retrospective review of fifty-five eyes of fifty-five patients who underwent 25-G TSV by five surgeons (MSH, EdeJ, TSC, JIL, LPC) at the Doheny Retina Institute. Diagnoses included epiretinal membrane (19), tractional retinal detachment (10), non-clearing vitreous hemorrhage (6), branch retinal vein occlusion (8), rhegmatogenous retinal detachment (6), submacular pharmacological injection (4), and macular hole (2). Main outcome measures were pre- and postoperative visual acuity (VA), keratometry (K), intraocular pressure (IOP); intraoperative surgical time, infusion volume, sclerotomy closure, complications; conversion to 20-gauge (20-G) sclerotomy; postoperative inflammation, presence of bleb or choroidal detachment. Results: Twenty-six males and twenty-nine females with a median age of 58 (range, 29 to 75) were followed for a median of 21 weeks (range, 1 to 35). All underwent monitored, local anesthesia. Preoperative VA ranged from 20/50 to HM (median = 20/100) and postoperative VA ranged from 20/20 to 20/200 (median=20/40). Preoperative K was 84.5 +/- 4.5 D and postoperative K was 84.5 +/- 4.0 D. Mean preoperative IOP was 18 mmHg (range, 12 to 22) and mean postoperative IOP was 14 mmHg (range, 6-24). Mean total surgical time was 38 minutes (range, 7.25 to 81.25). Mean opening time was 2.5 minutes (range, 1.5 to 5.0); mean vitrectomy time was 33.5 minutes (range, 5.0 to 65.0); mean closing time was 2.5 minutes (range, 1.0 to 6.0). Median infusion volume was 100 milliliter (range, 50 to 225). Eight eyes (16.7%) required a sclerotomy suture. Three eyes (5.4%) required conversion to 20-G. Sixteen eyes (29%) presented on day one with blebs; two remained at day seven. All resolved by day thirty. Fifteen eyes had shallow choroidal detachments; six persisted at day seven. All resolved by day thirty. Four-fifths of eyes revealed zero inflammation by day thirty. Two patients developed postoperative retinal detachments that were successfully reattached. One patient developed culture-negative endophthalmitis successfully treated by 20-G vitrectomy and intravitreal antibiotics. Conclusions: 25-G TSV decreases inflammation, surgical time, anesthesia risks and causes minimal astigmatic corneal change, resulting in faster postoperative recovery. A multicenter, prospective study is warranted to further examine this new surgical option.

Keywords: vitreoretinal surgery • retina • retinal detachment