Safety and efficacy of transconjunctival sutureless 23-Gauge vitrectomy for posterior segment diseases

ABSTRACT

To describe the initial experience, effectiveness, and safety profile of 23-gauge instrumentation for a variety of vitreoretinal conditions. A retrospective review of 30 consecutive 23-gauge vitrectomy cases done by a single vitreoretinal surgeon for various posterior segment conditions was done. All surgeries were performed using the two-step 23-gauge system developed by Dutch Ophthalmic Research Center [DORC]. All patients had at least 3-month follow-up. Main outcome measures included surgical success, visual acuity, intraocular pressure, and operative complications. Mean follow-up was 7.7 months [range 3-12 months]. Indications for surgery included rhegmatogenous retinal detachment [n=8], nonclearing vitreous hemorrhage [n=6], tractional retinal detachment [n=5], macular hole [n=5], epiretinal membrane [n=3], retained lens fragments [n=2] and endophthalmitis [n=1]. Gas tamponade was used in 18 eyes [60%] and silicone oil in six eyes [20%]. Mean overall preoperative visual acuity was 20/1053 and final acuity was 20/78 [P=0.001]. Mean intraocular pressure after 6 hours was 15.1mmHg [range 4-25 mmHg] and on postoperative day one was 14.5 mmHg [range 2-21 mmHg]. Four eyes [13.3%] required suturing of sclerotomy intraoperatively. Conversion to 20-gauge was done in one eye [3.3%]. Hypotony was reported in one eye [3.3%] postoperatively. Subconjunctival silicone oil reported in one eye [3.3%]. There were no postoperative complications of endophthalmitis, retinal or choroidal detachment. Twenty-three-gauge transconjunctival sutureless vitrectomy was effective in the management of wide variety of vitreoretinal surgical indications. The safety profile compared favorably with published rates for 25-gauge systems