Surgical Outcome and Significance of Silicone Oil Tamponade for Inferior Rhegmatogenous Retinal Detachment

PURPOSE: To compare the surgical outcomes of 23-gauge transconjunctival sutureless vitrectomy (TSV) with silicone oil tamponade versus 20-gauge PPV with sclera buckling (SB) and SF6 gas tamponade for the repair of rhegmatogenous retinal detachment (RRD) with inferior breaks. In addition, silicone oil tamponade was evaluated as an alternative option for patients with inferior RRD. METHODS: Two different types of surgery were performed on two groups of patients with inferior RRD: 23-gauge TSV with silicone oil tamponade (group 1) and 20-gauge PPV with SB and SF6 gas tamponade (group 2). The preoperative clinical features, anatomical success rate, complications, functional outcomes (visual acuity, VA, intraocular pressure, IOP), and surgical time were retrospectively evaluated. RESULTS: The primary surgical success rates were 94% and 78% in groups 1 and 2, respectively. The final success rate was 100% in both groups. Therefore, in terms of success rate, there was no difference between the two groups. No statistically significant difference in IOP change or complication rate was observed between the two groups. VA change was significantly better and surgical time was shorter in group 1. CONCLUSIONS: No statistically significant difference of anatomical success rate or complication rate between 23-gauge TSV with silicone oil tamponade and 20-gauge PPV with SB and SF6 gas tamponade was found for inferior RRD. However, surgical time was shorter in group 1. A 23-gauge TSV with silicone oil tamponade could be an alternative to 20-gauge PPV with SB and SF6 gas tamponade for patients with inferior RRD, especially patients who cannot maintain a prone posture.

Primary 23 Gauge Transconjunctival Sutureless Vitrectomy With Air Tamponade for Simple Rhegmatogenous Retinal Detachment

PURPOSE: To evaluate the surgical outcomes of primary 23-gauge (23G) transconjunctival sutureless vitrectomy (TSV) with air tamponade in patients with idiopathic simple rhegmatogenous retinal detachment (RRD). METHODS: A chart review of 38 eyes with idiopathic simple RRD which underwent primary 23G TSV with air tamponade and without prone positioning by a single vitreoretinal surgeon was retrospectively performed. All cases were followed up for a minimum of 3 months after the operation. RESULTS: The primary anatomical success rate was 94.7% (36/38 eyes). Preoperative mean logMAR (Snellen) best corrected visual acuity (BCVA) was 0.81 +/- 0.13 and improved to 0.63 +/- 0.37 and 0.48 +/- 0.37 at postoperative 1 week and 3 months (p < 0.05), respectively. The mean 21.35% amount of air bubble remained in the vitreous cavity at postoperative 1 week and the residual air bubble was completely absorbed at postoperative 2 weeks. Complications were sclerotomy site leakage (1 eye), cataract (3 eyes), vitreous hemorrhage (1 eye), epiretinal membrane (2 eyes) and increased intraocular pressure (3 eyes). CONCLUSIONS: The use of 23G TSV with air tamponade in cases with idiopathic simple RRD may be an effective and safe surgical technique.

The Clinical Outcomes of 23-Gauge Transconjunctival Sutureless Vitrectomy for Endophthalmitis after Cataract Surgery

PURPOSE: To report the clinical outcomes and utility of 23-gauge (G) transconjunctival sutureless vitrectomy (TSV) in patients with postoperative endophthalmitis following cataract surgery. METHODS: The medical records of 16 patients (17 eyes) who underwent 23-G TSV between January 2008 and December 2009 at Konyang University Hospital due to postoperative endophthalmitis following cataract surgery were retrospectively analyzed. The pre- and post-operative best-corrected visual acuities (BCVA), changes in intraocular pressure, the time from diagnosis to surgery, the intraoperative and postoperative complications, and the average duration of hospitalization were investigated. RESULTS: The mean BCVA significantly improved from log MAR 1.89 +/- 1.03 to log MAR 0.42 +/- 0.82 (p = 0.001), and the mean intraocular pressure changed from 16.1 +/- 4.1 mm Hg at baseline to 16.2 +/- 3.3 mm Hg on the first postoperative day without any significant difference (p = 0.955). In addition, none of the patients required sutures to treat wound leakage or showed hypotony on follow-up observation. The average operation time was 64.7 +/- 22.5 minutes, and the average duration of hospitalization was 5.4 +/- 4.5 days. CONCLUSIONS: The use of 23-G TSV in patients with postoperative endophthalmitis following cataract surgery may offer more convenience for the surgeon and more comfort for the patient. In addition, the patient may return to normal life earlier with a shortened duration of hospitalization.

A Case of Acute Endophthalmitis After 23-gauge Transconjunctival Sutureless Vitrectomy

PURPOSE: To report a case of acute endophthalmitis associated with 23-gauge transconjunctival sutureless vitrectomy and gas tamponade for macular hole surgery. CASE SUMMARY: A 66-year-old female patient who presented with a macular hole in the left eye was treated with 23-gauge transconjunctival sutureless vitrectomy. On postoperative day 2, the patient developed acute endophthalmitis and was treated with gas-fluid exchange, lensectomy and intravitreal antibiotic injection. Staphylococcus epidermidis was detected in the vitreous fluid of the operated eye. Intraoperative fundus findings showed severe retinal hemorrhage, vascular occlusion and fibrous membranes due to inflammatory response. After treatment, the patient's fundus findings markedly improved and the inflammatory response was controlled. CONCLUSIONS: Acute endophthalmitis after sutureless vitrectomy performed via intraocular gas injection may quickly result in inflammation and disease due to infection. Immediate reoperation and intravitreal antibiotic injections are recommended in such cases.

The 23-Gauge Sutureless Vitreoretinal Surgery in Previously Vitrectomized Eyes

PURPOSE: To investigate the incidence and risk factors of major complications including postoperative hypotony after 23-gauge transconjunctival sutureless vitrectomy in previously vitrectomized eyes. METHODS: The authors retrospectively reviewed medical records of 52 eyes, which underwent 23-gauge transconjunctival sutureless vitrectomy of previously vitrectomized eyes by a single surgeon. Major outcomes were postoperative hypotomy (<6 mmHg), intraoperative sclera shrinkage during sclerotomy,and other postoperative complications. Multiple logistic regression analysis was performed that included 212 eyes with primary vitreoretinal surgery in order to validate secondary vitreoretinal surgery as a significant risk factor of postoperative hypotony. RESULTS: Postoperative hypotony occurred in 4 eyes (7.7%) out of 52 eyes that underwent a second vitrectomy. The odds ratio of the second vitreoretinal surgery (OR=1.15, p=0.283) was not significant by multiple logistic regression analysis that included age, sex, axial length of globe, and the number of surgeries as the independent variables. Choroidal detachment occurred in one eye but disappeared three days later. The intraocular pressure was normalized within one week in all cases. Scleral shrinkage during sclerotomy occurred in five eyes (9.6%), and there were no other major complications, such as endophthalmitis. CONCLUSIONS: A 23-gauge transconjunctival sutureless vitrecomy of previously vitrectomized eyesshowed a 7.7% incidence of postoperative hypotony and favorable prognosis.

Comparison of Silicone Oil Removal Using 23-Gauge and 20-Gauge System for Pars Plana Vitrectomy

PURPOSE: The purpose of this study was to compare the clinical results of silicone oil removal using a 23-gauge transconjunctival sutureless pars plana vitrectomy (TSVS) and the 20-gauge pars plana vitrectomy (PPV) system and to evaluate the clinical value of 23-guage PPV system in silicone oil removal. METHODS: Eight eyes of 8 patients who received removal of silicone oil using the 23-gauge TSVS and 6 eyes of 6 patients using the 20-gauge PPV system were included in this study. The total operation time, silicone oil removal time, intraoperative and postoperative advantages, shortcomings, and complications were compared. RESULTS: The operation time and silicone oil removal time were 44.6+/-14.1 minutes, 42.7+/-10.5 minutes and 2.0+/-0.9 min/cc, 1.4+/-0.6 min/cc when silicone oil removal was performed using 23-gauge TSVS and 20-gauge PPV system, respectively. They were not significantly different (p=0.80, 0.22). Attention for the complete removal of the oil is necessary because of the intraocular trocar length when the 23-gauge TSVS is used. There were no complications except transient hypotonies (2 eyes), transient hypertonies (2 eyes) in the 23-gauge system and transient hypertonies (2 eyes) in the 20-gauge system. CONCLUSIONS: The operation time for silicone oil removal using the 23-gauge TSVS was not different than that of the 20-gauge PPV system and can be performed safely without any particular complications. Care and precautionary measures are needed in order to remove silicone oil completely.