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Sho Yokoyama, Takashi Kojima, Toshio Mori, Taisuke Matsuda, Tadashiro Saeki, Hiroyuki Sato, Norihiko Yoshida, Tatsushi Kaga, Kazuo Ichikawa; Comparison of surgical outcomes between 23-gauge and 25-gauge endoscope-assisted vitrectomy for treatment of rhegmatogenous retinal detachment. Invest. Ophthalmol. Vis. Sci. 2017;58(8):4168.
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When performing vitrectomy for rhegmatogenous retinal detachment (RRD), the use of ophthalmic endoscope has some advantages. One is being able to complete subretinal fluid drainage through the primary retinal breaks by tilting the patient’s head position without using perfluorocarbon liquids or creating intentional retinotomy for drainage (Figure 1), the other is eliminating the possibility of overlooking retinal breaks during surgery because the surgeon can stably observe all aspects within the fundus and can additionally visualize a magnified image when the endoscope approaches close to the fundus. Also, the ophthalmic endoscope of micro-incision vitrectomy surgery (MIVS) system has been developed in recent years. However there is no previous report on the usefulness and comparable of the ophthalmic endoscope of MIVS in cases with RRD. Therefore, in the current study we compared the relative surgical outcomes between 23-gauge and 25-gauge ophthalmic endoscopic vitrectomy in patients with RRD.
We examined 127 eyes from patients who underwent repair of RRD by 23- or 25-gauge vitrectomy, with a minimum follow-up of 3 month. Eyes with the following criteria were excluded: Giant tears, proliferative vitreoretinopathy grade C, dense vitreous hemorrhage, retinal detachment secondary to other ocular diseases, and prior retinal or vitreous surgery. Ninety-three eyes underwent vitrectomy with a 23-gauge system, and 34 eyes with a 25-gauge. Success rates, surgery time, and visual acuity scores were compared between the two groups.
Baseline, preoperative, and intraoperative characteristics showed no statistically significant differences between the two groups. The success rate after initial surgery was 91/93 (97.8%) and 34/34 (100%) for the 23- and 25-gauge groups, respectively (p=1.0). Total surgery time was 60.5±25.6 minutes and 57.1±28.5 minutes in 23- and 25-gauge group, respectively (p=0.40). Pre- and postoperative mean best-corrected visual acuity in the 23-gauge group significantly improved from 20/100 to 20/20 (p<0.0001), and that of the 25-gauge group improved from 20/100 to 20/25 (p=0.0002).
The 23-gauge and 25-gauge endoscope-assisted vitrectomies were equally effective and the both groups were higher success rates for the treatment of RRD.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
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