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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 discuss the clinical efficacy of 27-gauge (27G) vitrectomy with proliferative membrane cutting in situ for late proliferative diabetic retinopathy (PDR). ·METHODS: Collecting 10 cases (15 eyes) with late PDR from January 2017 to August 2017 which underwent 27G microincision vitrectomy with cutting proliferative membrane in situ, we observed the rate of intraoperative iatrogenic retinal hole ( IRH ), the rate of silicone oil tamponade, the best corrected visual acuity ( BCVA) and intraocular pressure (IOP) before and after operation. ·RESULTS: IRH occurred in 4 eyes (27%, 4/15); Silicone oil was tamponaded in 6 eyes (40%, 6/15); BCVA was improved in 13 eyes and only 2 eyes unchanged 3mo after operation. The best visual acuity (VA) was 0. 6. There was significant difference on BCVA between preoperative and postoperative 7d(P<0. 05). The same was found between preoperative and postoperative 1mo, even 3mo(P<0. 05). The average preoperative IOP was 16. 95 ± 6. 87mmHg and postoperative 3mo was 15. 27 ± 4. 57mmHg. There was no significant difference between them (P>0. 05). · CONCLUSION: The 27G vitrectomy with cutting proliferative membrane in situ method is markedly superior in the treatment of late PDR, and the curative effect is specific. It can be given preference to late PDR.
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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 evaluate the feasibility and advantages of two-port 27-gauge pars plana vitrectomy for treatment of recurrent retinal detachment in silicone oil dwelling eyes.METHODS:A retrospective study.Two-port 27-gauge pars plana vitrectomy was performed in 7 eyes with recurrent retinal detachment without remove of silicone oil.Proliferative membrane peeling, endolaser treatment, and drainage of subretinal fluid were performed.Scleral bulking was performed if necessary.RESULTS:Sucessful retina re-attachment was accomplishied in all eyes.No visually significant intraoperative complication occurred.All eyes expericend quick recoveray of visual acuity and mild postoperative irritation.One eye developed a recurrent inferior retinal detchment in 20d after the surgery using non-remove technique, and recovered after conventional silicone oil removal and retinal reattachment surgery.CONCLUSION:Two-port 27-gauge pars plana vitrectomy is an efficacious (and potentially cost-efficient) method to treat early stage recurrent retinal detachment in silicone oil dwelling eyes.
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Abstract?Since the introduction of 25-gauge/23-gauge ( 25G/23G ) sutureless micro -incision vitrectomy surgery ( MIVS ) at the beginning of the 21 century, we have stepped into an era of micro-incision vitreoretinal surgery more than10a. The current 25/23G MIVS provide numerous advantages over the conventional 20G vitrectomy surgery including simplified surgical procedure, shortened operating time, decreased complications as well as smaller sclerotomy wound.As a result, vitreoretinal surgeons have been shifting gradually from 20-gauge to 25/23-gauge vitrectomy in the past decade. As the 25/23G MIVS adapted worldwide, however, its drawbacks were also increasingly reported. Most criticism regarding to current 25/23G MIVS are focusing on would sealing related complications.Based on stablished notion regarding vitrectomy -“the smaller the better”, researchers and doctors were keeping on exploring the next generation of vitrectomy system. Thanks to the innovation and development in new generation vitrectomy machines, high lumen output light source, more delicate manufacturing technology and clear wild angle fundus view system, Dr.Oshima from Japan launched the first 27-gauge vitrectomy surgery system.It provided us novel surgical experience with smaller sclerotomy wound and faster cut rate. Further development and refinement of vitrectomy with 27-gauge or more are still on its way and will continue in the future. Undoubtedly, MIVS would be heated debated regarding its pro/con, complications, indications and future development.Combined with our own experiences, here we briefly reviewed the 27-gauge vitrectomy surgery.