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AIM: To comparatively analyze the efficacy and safety between 25-gauge(25G+)and 27G+ micro-invasive vitrectomy for the treatment of vitreoretinal diseases.METHODS: The clinical data of 89 cases(89 eyes)of vitreoretinal disease who received vitrectomy at our hospital from March 2019 to April 2022 were retrospectively analyzed. They were divided into two groups according to surgery. A total of 45 cases(45 eyes)who received 25G+ micro-invasive vitrectomy were included in group A, and 44 cases(44 eyes)who received 27G+ micro-invasive vitrectomy were included in group B. Vitrectomy time, operation time, preoperative and postoperative best corrected visual acuity(BCVA), intraocular pressure, subjective comfort evaluation results and complications of the both groups were analyzed.RESULTS: There were no differences in vitrectomy time of the two groups(P>0.05), while the operation time of group B was shorter than that of group A(35.50±14.27min vs. 41.73±14.25min, P=0.042). The postoperative BCVA of the two groups were better than that before operation(P<0.05), while there was no significant difference between two groups(P>0.05). The postoperative intraocular pressure of the two groups was lower than that before operation(P<0.05), and it was slightly lower than group B at 1 and 7d after operation(P<0.05). As for the subjective comfort evaluation results, the scores of group A was higher than that of group B at 1d after operation(6.13±1.20 vs. 3.45±1.17, P<0.001); and there were no differences between two groups at 7d after operation(2.18±1.01 vs. 1.93±0.87, P=0.215). During the follow-up, 7(16%)eyes of incision leakage occurred in group A, of which 6(13%)eyes were transient hypotony, and 10(22%)eyes had conjunctival chemosis. In the group B, there was no incision leakage and transient hypotony, while conjunctival chemosis occurred in 2(4%)eyes at 1d after operation.CONCLUSION: Both 25G+ and 27G+ micro-invasive vitrectomy can improve visual acuity, stabilize intraocular pressure and be safe in patients with vitreoretinal disease. However, 27G+ micro-invasive vitrectomy has less leakage, stable intraocular pressure, shorter operation time and lower incidence of conjunctival chemosis.
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AIM: To compare the efficacy of 25-gauge(25G)vitrectomy combined with intraocular lens transciliary sulcus scleral suture fixation and sutureless scleral tunnel interlamellar fixation in the treatment of complete lens dislocation.METHODS: Retrospective case-control study. A total of 40 patients(40 eyes)diagnosed with complete lens luxation in the vitreous cavity in our hospital from May 2015 to September 2021 were selected, among which 21 eyes(suture group)underwent 25G vitrectomy combined with intraocular lens fixation via ciliary sulci scleral suture, and 19 eyes(sutureless group)underwent 25G vitrectomy combined with interlamellar scleral tunnel fixation of intraocular lens. The patients in both groups were followed up until 3mo after surgery to observe the operative time, best corrected visual acuity(BCVA), corneal endothelial cell count(CECC), central corneal thickness(CCT)and postoperative complications.RESULTS: The operation time was significantly shorter in the sutureless group than in the suture group(31.79±6.01min vs. 45.38±8.04min, P<0.001). BCVA in both groups was significantly improved after surgery(all P<0.05), and the BCVA(LogMAR)at 1wk after operation in the sutureless group was significantly better than that in the suture group(0.32±0.14 vs. 0.57±0.25, P<0.001). At 3mo after surgery, CECC in both groups was lower than that before surgery(all P<0.01). The CCT at 1wk after operation in the suture group was greater than that before operation and at 3mo after operation(all P<0.01), and there was no significant change in CCT before and after surgery in the sutureless group. During follow-up period, the total complication rate in the sutureless group was lower than that in the suture group(26% vs. 38%, P>0.05).CONCLUSION: 25G vitrectomy combined with intraocular lens sutureless scleral tunnel interlamellar fixation in the treatment of complete lens luxation has shorter operation time, faster postoperative visual acuity improvement and fewer postoperative complications.
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@#At present, the occurrence and development of cataract in patients operated by vitrectomy is more common. The patient, who would be in cataract surgery, is prone to suffering from higher risks and complications in eyes if he had vitrectomy before than those without vitrectomy. Consequently, it is a significant challenge for ophthalmologists to determine the choice of surgery and the operation during surgery. Compared with cataract surgery after vitrectomy without perfusion, phacoemulsification with 25-gauge perfusion is an effective method, which can maintain the intraocular pressure, stabilize the anterior chamber, and reduce the intraoperative and postoperative complications. In conclusion, phacoemulsification with 25-gauge perfusion is a preferred method for cataract patients after vitrectomy.
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Purpose: To assess the influence of orientation of the external linear incision created by the trocar and related factors on sclerotomy closure in 25-gauge (25G) transconjunctival vitreous surgery (TVS). Methods: A total of 46 eyes of 46 patients who underwent 25G TVS (23 circumferential incisions and 23 radial incisions) were studied. Clinical and anterior segment optical coherence tomography (AS-OCT)-based comparison of self-sealed and sutured sclerotomies was done. The influence of age, ocular surgeries and injections, axial length, cannula type, sclerotomy quadrant, surgery duration, vitreous base excision, and tamponade on suture rates was analyzed. Results: Of the 46 eyes, 23 eyes required suturing [circumferential: 17 (74%) and radial: 6 (26%); P = 0.003]. A significantly lesser proportion of superonasal quadrant and inferotemporal quadrant sclerotomies needed suturing [9 (24%) and 12 (27%)] when compared with superotemporal quadrant [17 (37%)]. Sclerotomies to the left of the surgeon and the infusion port required significantly lesser suturing [10 (25%) and 13 (28%), respectively] when compared with that of surgeon's right [15 (35%)]. Suturing was significantly lesser when gas or oil tamponade was used [5 (36%) and 2 (20%), respectively] when compared with no tamponade [16 (73%)]. In eyes without tamponade, suturing was lesser with radial sclerotomies (P = 0.003). The odds of having an open sclerotomy tract on AS-OCT were ?5 when circumferential sclerotomies were used. Conclusion: Self-sealing was more common with radial external incisions. Tamponade was associated with less suturing. Superotemporal sclerotomies and sclerotomies toward the surgeon's dominant hand were often sutured. In this cohort, other factors did not influence sclerotomy closure.
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·AIM:To compare the short-term surgical results of 27-gauge ( 27G ) with 25 - gauge ( 25G ) microincision vitrectomy surgery ( MIVS ) for the treatment of vitreoretinal diseases and evaluate the feasibility, safety and effectiveness of 27G MIVS. · METHODS: Two hundred and seventeen eyes with various vitreoretinal diseases underwent 27G or 25G MIVS from April 2016 to October 2017 and were retrospectively reviewed. One hundred and thirty-five eyes underwent 27G vitrectomy and 82 eyes for 25G vitrectomy. The main outcome measurements of the study included surgical time, intraoperative complications, postoperative ocular inflammation reaction, short-term best corrected visual acuity ( BCVA, LogMAR ) recovery and intraocular pressure fluctuation. ·RESULTS: All surgeries were completed successfully, and no eye in 27G group needed conversion to 25G vitrectomy. The mean surgical times in the 25G group was 56. 4±38. 9 min, which was significant longer than that of 27G group (45. 5 ± 26. 1 min, t= 2. 422, P= 0. 016). However, when comparing the surgical time for each category of disease, there were no significant differences observed (P>0. 05). Within the first week postoperatively, the mean cumulative score of conjunctival congestion, anterior chamber flare and aqueous cell in 25G group were 2.4±1.4, 0.7±1 and 0.5±1, which were higher than those in 27G group (2. 1 ± 1. 6, 0. 3 ± 0. 6, and 0. 2 ± 0. 4), with significant differences (P=0. 038, P=0. 011, P=0. 046 respectively). The improvement of BCVA was-0. 4±0. 9 in 25G group, and -0. 2 ± 0. 9 in the 27G groups respectively (t= -1. 636, P = 0. 103 ). The rate of transient ocular hypotony of the 25G vitrectomy was 19. 5% (16 eyes), which was higher than that of the 27G group without significant difference ( 15. 6% , 21 eyes; χ2= 0. 565, P=0. 452). When the eyes injected with silicone oil were excluded, there was no significant difference in intraocular pressure fluctuation between the 25G group (3. 59±0. 69mmHg) and the 27G group (3. 58±0. 47mmHg;t=0. 007, P=0. 995). ·CONCLUSION: The 27G microincision vitrectomy can be used to treat various vitreoretinal diseases. It is a safe and effective surgical procedure with small incision and mild anterior segment inflammatory reaction.
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AIM: To explore the clinical value of 25 - gauge vitrectomy in the treatment of traumatized eyes with non-light perception.?METHODS:Forty-six patients (46 eyes) who diagnosed as traumatized eyes with non-light perception treated with 25-gauge vitrectomy, which collected in our hospital from July 1, 2013 to June 1, 2017. Their sex, age, residence area, traumatic nature, causes of injury, duration from the injury to intervention, location and size of the wound, visual acuity and prognosis was retrospectively studied and analyzed statistically in this study.?RESULTS: In the 46 patients, 38 were males, 8 were females (M :F= 4. 75:1). The age of the patients was between 7 and 77 years ( mean 37. 96 ± 18. 99 years). Among them, there were 26 case ( 57％) in the young group (<45 years ) , 14 case ( 30％) in the middle age group ( 45-60 years ) , 6 cases ( 13％) in the older age group (>60 years ) . The cause of injury included blunt trauma ( 18 cases, 39％) , sharp instrument injury ( 8 cases, 17％) , plant injury ( 6 cases, 13％) , explosion injury (6 cases, 13％), impact injury (4 cases, 9％), limb impact injury ( 2 cases, 4％) , traffic accident injury ( 2 cases, 4％) . There were 33 cases ( 72％) with ocular rupture, 12 cases (26％) with perforating injury of eyeball and 1 case ( 2％) with ocular contusion. There were 44 cases (96％) with vitreous hemorrhage, 30 cases (65％) with retinal detachment, 18 cases ( 39％) with intraocular foreign body (IOFB), 22 cases (48％) with cilio-choroidal detachment, 18 cases (39％) with endophthalmitis and 12 cases (26％) with retinal hemorrhage. The postoperative best-corrected visual acuity improved to light perception or better than light perception in 30 cases ( 65％) , and 16 cases (35％) still had no light perception.? CONCLUSION: The patients who had no light perception after ocular trauma were almost young and middle- aged people in rural areas. The factors that affected the visual acuity of the postoperative included the type of injury, the location and size of the wound, the retinal detachment, the cilio-choroidal detachment, the duration from the injury to intervention, the endophthalmitis and whether the merger of intraocular foreign body or not. The 25-gauge vitrectomy could make most of the visual acuity from no light perception to light perception or over the light perception, which had a high clinical value in curing traumatized eyes with no light perception.
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PURPOSE: To evaluate anatomical and visual results of transconjunctival 25-gauge plus pars plana vitrectomy (PPV) in the management of primary rhegmatogenous retinal detachment (RRD). METHODS: A retrospective analysis of 46 eyes of 46 patients who underwent transconjunctival 25-gauge plus PPV for primary RRD repair between January 2013 and May 2013 with a minimum of 3-month follow-up was performed. Data collected for the study included patient demographics, lens status, preoperative visual acuity, macular status, and location and number of primary breaks. Main outcome measures were anatomical reattachment rate, postoperative visual acuity, operation time, and postoperative complications. RESULTS: The study included 30 men and 16 women. The mean age of the patients was 54.3 years. The locations of retinal breaks were 24 (52.2%) eyes in the superior half, 15 (32.6%) eyes in the inferior half, and 7 (15.2%) eyes on both sides. The macula-on RRD was present preoperatively in 21 (45.7%) of 46 eyes. Of the 33 (71.7%) phakic eyes, 18 (39.1%) underwent combined phacoemulsification, intraocular lens implantation, and PPV. Two different tamponades, C3F8 gas and silicone oil were used in this study. C3F8 gas was injected in the 33 (71.7%) eyes, and the remaining eyes were filled with silicone oil (1,300 centistokes for 11 eyes, 5,700 centistokes for 2 eyes). Mean operation time was 48.8 +/- 13.2 minutes. Retinal reattachment was achieved in 45 (97.8%) of 46 eyes at 3 months. Mean best-corrected visual acuity improved from 1.33 +/- 1.20 log MAR preoperatively to 0.68 +/- 0.94 log MAR postoperatively (p < 0.001). Postoperative complications included transient intraocular pressure elevation in 6 (13.1%) eyes and posterior capsular opacity in 3 (6.5%) eyes. CONCLUSIONS: It seems that transconjunctival 25-gauge plus PPV can be a safe and effective option for surgical management of RRD.
Subject(s)
Female , Humans , Male , Demography , Follow-Up Studies , Intraocular Pressure , Lens Implantation, Intraocular , Outcome Assessment, Health Care , Phacoemulsification , Postoperative Complications , Retinal Detachment , Retinal Perforations , Retinaldehyde , Retrospective Studies , Silicone Oils , Visual Acuity , VitrectomyABSTRACT
PURPOSE: To report a case of endophthalmitis after 25-gauge transconjunctival sutureless vitrectomy. METHODS: A 60-year-old male patient underwent 25-gauge transconjunctival sutureless vitrectomy through the epiretinal membrane. He was diagnosed as endophthalmitis on 7th postoperative day. Immediate vitrectomy and intravitreal antibiotics injection was done. RESULTS: Coagulase-negative staphylococcus was identified in vitreous culture and incarcerated vitreous through the previous unsutured sclerotomies were found. During vitrectomy, we found generalized retinal necrosis and vascular occlusion with retinal hemorrhage, cheese like thick membrane firmly adherent to the retina due to inflammatory response. The organism was sensitive to antibiotics administered. After treatment, inflammatory response was controlled and the retina became stable but the visual outcome was poor. CONCLUSIONS: Vitreous incarceration through unsutured sclerotomy may occur after 25-gauge transconjunctival sutureless vitrectomy. This can be a possible conduit for bacteria in the eye and be a cause of endophthalmitis. Sutureless sclerotomy should be carefully monitered and managed postoperatively.