A comparative study of 25G+ versus 27G+ vitrectomy for the treatment of idiopathic macular hole / 国际眼科杂志(Guoji Yanke Zazhi)

AIM:To compare the clinical effects of 25G+ and 27G+ transconjunctival sutureless vitrectomy in treating idiopathic macular hole.METHODS: We retrospectively reviewed the clinical outcomes of 56 eyes (56 patients) with idiopathic macular hole which were treated with micro-incision vitrectomy from June 2015 to September 2016.Patients were divided into two groups, 28 patients (28 eyes) were treated with 25G+ vitrectomy and the rest (28 eyes) were treated with 27G+ vitrectomy.The operative time and intraoperative complications were recorded and patients were followed up for 3-6mo.During the follow up period, best correct vision acuity (BCVA), intraocular pressure, macular hole healing and postoperative complications were documented and statistically analyzed.RESULTS: BCVA in two groups were significantly improved after surgery(P<0.001) and there was no significant difference between the two groups(P=0.84).No serious complications occurred.No statistically significant difference was found between the two groups in surgical time and healing rate of macular hole (P=0.57, 0.64).The incidence of low intraocular pressure (IOP<10mmHg) in 27G+ group was lower than that in 25G+ group on the first day after surgery(P=0.31).There was no significant difference between preoperative and postoperative intraocular pressure at 1wk after operation in both groups (P=0.72, 0.92).CONCLUSION: Both 25G+ and 27G+ vitrectomy are safe and effective technique in treating idiopathic macular hole.Besides, 27G+ showed better superiority on the maintenance of intraocular pressure and reduce the trauma.

Clinical Curative Effect of Vitreous Cavity Injection Combined with Transconjunctival Sutureless Vitrectomy on the Patients with Poliferative Diabetic Retinopathy / 现代生物医学进展

Objective:To investigate the clinical curative effect of vitreous cavity injection combined with transconjunctival sutureless vitrectomy on the patients with poliferative diabetic retinopathy.Methods:80 patients with diabetic retinopathy were enrolled in our hospital from January 2014 to January 2016,in which contained 83 sicked eyes,and randomly divided into two groups.Group A (n=40,42 sicked eyes) accepted 25G transconjunctival sutureless vitrectomy,and Group B (n=40,41 sicked eyes) adopted intravitreal injection of conbercept based on patients in Group A.The operative conditions,best-corrected visual acuity (BCV) and retinal thickness were compared between two groups,and the incidence of adverse reactions within postoperative 1 month were recorded and analyzed.Results:The operation time of group B was significantly shorter than that of group A (P＜0.05).The percentage of using electric coagulation,operative bleeding and iatrogenic fracture space in group B were significantly lower than of those group A (P＜0.05).The percentage of neovascularization vanish in group B was significantly higher than that of group A (P＜0.05).The BVCA of patients in group B in postoperative 1 month and 3 month were higher than those of group A (P＜0.05).And the thickness of retinal in group B were significantly thinner than those of Group A (P＜0.05).The incidence of vitreous hemorrhage and hyphema in group B were significantly lower than those of Group A (P＜0.05).Conclusions:Vitreous cavity injection combined with transconjunctival sutureless vitrectomy improved the operative conditions and contributed to the recovery of postoperative visual acuity and retinal in the treatment of patients with poliferative diabetic retinopathy.

Clinical study of 23G transconjunctival sutureless vitrectomy for idiopathic macular hole / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To investigate the clinical effect of 23G transconjunctival sutureless vitrectomy(23G TSV)in the treatment of idiopathic macular hole. <p>METHODS: Totally 80 cases with macular hole treated in ophthalmology department of our hospital from January 2013 to June 2015 were selected as the research objects, in which 40 cases were treated with 23G TSV after admission, the other 40 cases were treated with 20G vitrectomy. The surgery time, length of hospital stay, changes of visual acuity, macular hole closure, macular thickness and complications were observed in two groups. <p>RESULTS: The surgery time, length of hospital stay and the complication rate of observation group were less than those of control group with significant difference(<i>P</i><0.05). The corrected visual acuity was significantly improved in both groups at 3, 6, 12mo after operations compared to before operations, but no significant difference were found between the two groups(<i>P</i>>0.05). Macular hole closure rate of observation group was 98%(39/40), that of control group was 95%(38/40), there was no significant difference between the two groups(<i>χ</i>2=0.346, <i>P</i>=0.553). The macular thickness significantly decreased in both groups at 3, 6, 12mo after operations compared to before operations, but no significant difference were found between the two groups(<i>P</i>>0.05).<p>CONCLUSION: 23G TSV is effective in the treatment of idiopathic macular hole with low complication rate, which is beneficial to improve the postoperative visual acuity and improve the prognosis.

Primary Repair of Rhegmatogenous Retinal Detachment Using 25-Gauge Transconjunctival Sutureless Vitrectomy

PURPOSE: To evaluate 25-gauge transconjunctival sutureless vitrectomy for primary repair of rhegmatogenous retinal detachment (RRD). METHODS: We performed a retrospective study of 46 consecutive eyes of 46 patients who underwent 25-gauge transconjunctival sutureless vitrectomy to repair primary RRD. Outcome measures included single surgery anatomical success rate, final anatomical success rate, postoperative visual acuity, and surgical complications. RESULTS: Forty eyes were phakic and six eyes were pseudophakic. Twenty-six eyes had superior quadrant retinal tear, 12 eyes had inferior quadrant tear and eight eyes had both. The mean operation time was 56.3 minutes. The single surgery anatomical success rate was 93.48% (43/46). Two eyes with recurrent retinal detachment underwent fluid gas exchange: one received barrier laser treatment in the outpatient clinic, and the other underwent reoperation; the final success rate was 100%. The best corrected visual acuity improved from 1.34 log MAR to 0.48 log MAR (p < 0.01) in macula - off patients (30 eyes) and from 0.32 log MAR to 0.07 log MAR (p = 0.279) in macula - on patients (16 eyes). Postoperative complications included wound leaking (two eyes), cataract progression (13 eyes), vitreous hemorrhage (one eye), transient hypotony (one eye), and increased intraocular pressure (seven eyes). CONCLUSIONS: Primary repair of RRD using 25-gauge transconjunctival vitrectomy resulted in an excellent final anatomical success rate and postoperative visual outcomes.

23-gauge vitrectomy with intraocular foreign body removal via the limbus: An alternative approach for select cases.

Purpose: To study the outcome of removal of retained intraocular foreign bodies (RIOFBs) via limbus using 23‑gauge transconjunctival sutureless vitrectomy (TSV). Materials and Methods: In this prospective, non‑comparative interventional case series, fourteen eyes of 14 patients fulfilling the inclusion criteria were enrolled. They underwent 23‑gauge TSV for management of posterior segment RIOFB and reviewed at 1 day, 7 days, 6 weeks, 3, 6 and 12 months. Eyes with penetrating eye injury involving cornea or limbus (corneal injury not so severe to hinder vitrectomy), cataract associated with anterior and/or posterior capsular tear requiring cataract surgery and posterior segment RIOFB with minimal posterior segment involvement were included. Main outcome measures include success in removal of RIOFB without enlarging sclerotomy, ability to preserve capsular support, improvement in visual acuity and complications, if any. Results: All eyes underwent the successful RIOFB removal through limbal port without enlarging scleral ports. None of the eyes required suturing of the sclera, cornea or conjunctiva. Anterior capsular rim could be preserved in all eyes except one. Postoperatively follow up ranged from one year in 8, 6 months in 4 and 3 months in 2 eyes. The mean logMAR visual acuity at 3, 6, and 12 months showed significant improvement. There were no intraoperative complications. Postoperative complications include microscopic hyphema and loose blood in vitreous cavity in one eye. Conclusion: The advantages of 23‑gauge TSV for removal of RIOFB may be passed on to select cases. RIOFB removal through limbal route obviated the need for scleral port enlargement and preserved capsular support for early visual rehabilitation.

Comparison of Surgically-induced Astigmatism after Combined Phacoemulsification and 23-Gauge Vitrectomy: 2.2-mm vs. 2.75-mm Cataract Surgery

PURPOSE: The 2.2-mm microincision cataract surgery and small-gauge vitrectomy system is known to result in less surgically-induced astigmatism (SIA) in comparison to conventional surgical methods. We compared the amounts of SIA after combined phacoemulsification and 23-gauge transconjunctival sutureless vitrectomy (23G-TSV) using the 2.2-mm microincision and 2.75-mm standard incision methods. METHODS: We studied 59 patients (61 eyes) who underwent combined phacoemulsification and 23G-TSV from November 2008 to September 2012. Twenty-eight patients (28 eyes) underwent 2.2-mm microincision coaxial phacoemulsification, and 31 patients (33 eyes) underwent 2.75-mm standard incision phacoemulsification. SIA was evaluated using Naeser's polar method with the simulated keratometric values obtained from corneal topography. Preoperative and 1-week and 1-month postoperative KP (Naeser's polar value along the specific axis) and DeltaKP values were compared between the 2.2-mm microincision and 2.75-mm standard incision groups. RESULTS: One week after surgery, both groups exhibited similar amounts of SIA (-DeltaKP[120], 0.40 +/- 0.41 vs. 0.51 +/- 0.56 diopters [D]; p = 0.390). One month after surgery, however, the amount of SIA was significantly smaller in the 2.2-mm microincision group as compared to the 2.75-mm standard incision group (-DeltaKP[120], 0.31 +/- 0.54 vs. 0.56 +/- 0.42 D; p = 0.045). CONCLUSIONS: In combined phacoemulsification with 23G-TSV, 2.2-mm microincision coaxial phacoemulsification induces less SIA than does 2.75-mm standard coaxial phacoemulsification.

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.

Influence of vitrectomy for corneal thickness in diaebetic retinopathy eyes with Pentacam / 中华实验眼科杂志

BackgroundThe research of corneal thickness after pars plana vitrectomy in DM patient plays an important role not only theoretically but clinically.Objective Present study was to evaluate the change in corneal thickness after pars plana vitrectomy.Methods A prospective coherent study was designed.Seventy-five eyes of 70 consecutive diabetic retinopathy(DR) patients were collected in Tianjin Medical University Eye Center.Pentacam was used to assess the central and periphery corneal thickness by the same investigator preoperatively and 7 days,1 and 3 months postoperatively,respectively.The thickness values from five corneal zone were obtained,including cornea vertex,the thinnest point of the cornea,periphery cornea near the scleral incision of 4 mm away to vertex of cornea on vertical and 240°,120°,60° meridian ( right eye) or 300°,120°,60° meidian ( left eye ).These results were compared and analyzed with ANOVA of repeated measurement data.Subgroup analysis was performed to evaluate the influence of different corneal positions,the use of conventional 20g or 23g transconjunctival sutureless vitrectomy(TSV) groups,surgery duration,gas or fluid endotamponde on corneal thickness.This study was approved by Ethic Committee of this hospital.Written informed consent was obtained from the subjects before any relative medical procedure.Results The mean corneal thickness was ( 639.9 ± 103.1 ),( 689.5 ± 119.3 ),( 666.5 ±113.7),( 650.8 ± 108.6 ) μm before operation,postperative 7 days,1 and 3 months respectively.As covariates appearing in the model,the corneal thickness change rates were revised as the parameters as following: diabeitc duration =13.0 and age =57.2.The revised corneal thickness was significant different among various time points( F=210.928,P=0.000) and different corneal zones(F=24.843,P=0.000) with the size order in turn P4＞P3＞P1＞P2＞P5.The corneal thickness change rates were less in 23g TSV group compared with conventional 20-g group (F =53.843,P =0.000) and BSS tamponade group compared with gas tamponade group ( F =5.288,P =0.022).But no significant difference was found in the revised corneal thickness among surgery duration ＜ 1 hour group,1-2 hour group and ＞2 hour group( F=1.233,P =0.293).ConclusionsVitrectomy is a safe procedure on the ground of cornea,but TSV and fluid endotamponade appear to be more beneficial to the protection of cornea.Pentacam could offer the reliable data in not only central cornea but also periphery cornea.

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 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 Intraocular Pressure Between Sutureless and Sutured 23-gauge Vitrectomy

PURPOSE: To compare 23-gauge transconjunctival sutureless vitrectomy (TSV) and sutured vitrectomy in the aspect of intraocular pressure (IOP) changes and complications. METHODS: Through a retrospective chart review, 45 sutureless patients (48 eyes) and 48 sutured patients (52 eyes) who had undergone 23-gauge transconjunctival vitrectomy by one surgeon (J.H. Sohn) were compared. IOP was measured routinely pre-operativley, at 1 day, 1 week, and 1 month post-operatively. Postoperative IOP, hypotony (IOP<7 mmHg) rates and complications associated with hypotony were assessed respectively. In addition, the cases involving intraocular air or gas tamponade or cataract extraction were compared. RESULTS: One day after the surgery, 3 eyes of the sutureless group developed hypotony,which persisted in 2 eyes through postoperative 1 week. Two eyes of the sutureless group developed hypotony 1 week after the surgery. Most of the hypotony cases were transient, but choroidal detachment occurred in 2 cases, and retinal detachment occurred in 1 case. In contrast, none of the sutured group developed hypotony. Intraocular air or gas tamponade significantly raised IOP 1 day after the surgery. When the operation was combined with cataract extraction, IOP was reduced postoperative 1 week and 1 month. CONCLUSIONS: The well-known risk factor of 23-gauge sutureless vitrectomy is postoperative hypotony. The present study showed postoperative hypotony can result in retinal detachment as a complication in contrast to previous studies. The authors conclude that suturing the wound for the prevention of hypotony is better, especially in cases with high risk of hypotony or definite wound leakage.

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.

Comparison Between 20-Gauge and 23-Gauge Vitrectomy System in Primary Vitrectomy for Rhegmatogenous Retinal Detachment

PURPOSE: The efficacy of 20-gauge and 23-gauge vitrectomy system was investigated in primary vitrectomy for rhegmatogenous retinal detachment. METHODS: Eyes that underwent primary vitrectomy without scleral buckling for the treatment of rhegmatogenous retinal detachment were followed up at least 6 months and were reviewed retrospectively. Anatomic results, functional outcomes, operation time and complications were compared between 20-gauge and 23-gauge groups. RESULTS: Among 59 eyes of 59 patients, the 20-gauge group had 29 eyes of 29 patients and 23-gauge group had 30 eyes of 30 patients. Anatomic success after a single operation was obtained in 23 eyes (79.3%) of the 20-gauge group and 28 eyes (93.3%) of the 23-gauge group. Recurrence occurred in 6 eyes (20.7%) in the 20-gauge and in 2 eyes (6.6%) in the 23-gauge group. Retinal reattachment in all of these eyes was obtained through reoperation. Visual acuity improved logMAR 0.2 or more in 19 eyes (65.5%) of the 20-gauge group and 20 eyes (66.7%) of the 23 gauge group (p=0.153, 0.215). The average operation time of the 23-gauge group was 80.2 minutes, which was significantly shorter than the 94.8 minutes of the 20-gauge group (p=0.008). Transient ocular hypertension and progression of lens opacity were the most common complications in the both groups. CONCLUSIONS: Twenty-three-gauge transconjuctival sutureless vitrectomy achieved outcomes comparable with 20-gauge vitrectomy, with significantly shorter operation time in repair of rhegmatogenous retinal detachment. It is considered as a viable alternative to 20-gauge vitrectomy in selected cases.

A Combination of 23-gauge and 20-gauge Transconjunctival Sutureless Vitrectomy

PURPOSE: To describe the clinical experience and safety profile of a combination of 23-gauge and 20-gauge transconjunctival sutureless vitrectomy (TSV) METHODS: Thirty-seven eyes of thirty-seven consecutive patients who underwent 23-gauge combined with 20-gauge transconjunctival vitrectomy surgery by a single surgeon from August 2006 through December 2006 were reviewed retrospectively for surgical indications, wound problems, and postoperative complications. RESULTS: Thirty-seven eyes, including eyes with proliferative diabetic retinopathy (n=24), macular hole (n=3), epiretinal membrane (n=3), vitreous hemorrhage due to branch retinal vein occlusion and choroidal neovascular membrane (n=3), vitreous opacity secondary to uveitis (n=1), rhegmatogenous retinal detachment (n=1), and vitreoretinal traction syndrome (n=1), underwent operation. Seven eyes at 23-gauge sclerotomy sites and 15 eyes at 20-gauge sclerotomy sites had subconjunctival hemorrhage. Three eyes required sutures at 20-gauge sclerotomy sites intraoperatively due to wound leakage. One wound hemorrhage occurred at a 23-guage sclerotomy site. Vitreous hemorrhage (4 eyes), hyphema (2 eyes), and vitreous hemorrhage with hyphema (1 eye) occurred postoperatively. Postoperative hypotony, retinal detachment, and other complications did not occur. CONCLUSIONS: A combination of 23-gauge and 20-gauge transconjunctival sutureless vitrectomy which was created by modifying transconjunctival sutureless vitrectomy systems published previously guarded against sclerotomy wounds and a variety of vitreoretinal surgical indications.

A Case of Endophthalmitis after 25-gauge Transconjunctival Sutureless Vitrectomy

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.

Vitreoretinal Surgery Using Transconjunctival Sutureless Vitrectomy

This report presents the effectiveness of 25-gauge Transconjunctival Sutureless Vitrectomy (TSV) for various vitreoretinal disorders. We performed vitreoretinal surgery on 6 patients using 25-gauge TSV. Minimal or no leakage of intraocular fluid or gas was observed at the entry site. No case required a suture to close the conjunctival or scleral opening site, and no complications resulted from the opening site. Median preoperative visual acuity was 0.04 and median postoperative best corrected visual acuity (BCVA) with a mean follow-up of 12 weeks, was 0.45. Median preoperative intraocular pressure was 12.67mmHg, and median intraocular pressure on the first postoperative day was 15.67 mmHg. Because transconjunctival sutureless surgery is minimally invasive, it increases the efficiency of vitrectomy, hastens postoperative recovery, and improves outcomes due to the simplified surgical procedure. We feel that the adoption of the 25-gauge TSV would lead to improved patient comfort, care, and management.