Early surgical results of a 23-gauge trocar combined with a one-directional valve system in primary and secondary pars plana vitrectomy (original) (raw)
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Pakistan journal of ophthalmology, 2013
To evaluate the safety of 3 port pars plana 23 gauge transconjunctival sutureless vitrectomy for vitreoretinal diseases. Material and Methods: A prospective study was conducted at the Institute of Ophthalmology, Mayo Hospital Lahore from July 2010 to December 2010. All patients were admitted in the eye ward from the outpatients department. Total 30 patients were included in the study. Male to female ratio was 70:30. Mean age of patients was 45.5 years. Those included had idiopathic epiretinal membrane (ERM), diabetic vitreous hemorrhage, traumatic vitreous haemorrhage, vitreous haemorrhage secondary to Eale's disease, diabetic macular edema, macular hole, Diabetic (tractional retinal detachment) TRD and dislocated lens. Outcome measures were recorded at baseline, 1 day, 1 week and 1 month, 2 months and 3 months post operatively. Applanation tonometery, intra & post-operative complications, ancillary tests such as ocular coherence tomography (OCT) and ultrasound were done as required. Results: Intra-operative complications noted were retinal tear 9% (2.7 patients), lens touch 4% (1.2 patients), sclerotomy leak requiring stitches 35% (10.5 patients), conjunctival hemorrhage 31% (9.3 patients), cannula slippage 13% (3.9 patients), entry site break 4% (1.2 patients) and retinal touch 4% (1.2 patients). First day post-operative complications were hypotony 20%, conjunctival inflammation 30%, mild eye discomfort 23.3% & corneal edema 13.3%. No complication was noted on 7 th post operative day. Conclusion: This study showed that procedure is safe and can be adopted in different vitreoretinal procedures. It is minimally invasive surgical technique that enhances the postoperative recovery and outcomes by simplifying the surgical procedure. T
Outcomes of 23-gauge pars plana vitrectomy in vitreoretinal diseases
Clinical Ophthalmology, 2011
The aim of this study was to assess the efficiency and reliability of the 23-gauge (23G) transconjunctival vitrectomy system and examine possible complications of this surgical technique in a variety of vitreoretinal conditions along with early postoperative intraocular pressure (IOP) changes. Materials and methods: A total of 350 eyes of 324 patients having undergone 23G transconjunctival vitrectomy were included in this prospective study. A total of 150 (46.2%) were male and 174 (53.8%) female, with a mean age of 61.28 ± 15.67 years. Mean follow-up time was 8.3 months. Results: Mean BCVA logMARs were as follows: preoperatively 0.839 ± 0.59, postoperatively first day 2.07 ± 0.76, first week 1.14 ± 0,43, first month 0.63 ± 0.26 and last examination 0.359 ± 0.17. Mean BCVA decreased significantly (P , 0.001, P , 0.028, respectively) on postoperative first day and first week, mainly due to air or gas tamponade, and increased significantly in the first month and final control in almost all indications (P , 0.001). Postoperative mild hypotony (IOP # 10 mmHg) was detected in 112 (32%) eyes on day 1 and in 59 (16.8%) eyes in week 1. While postoperative serious hypotony (#5 mmHg) was detected in 34 (9.7%) eyes on day 1, it was not detected in any eyes at the end of the first week. None of the eyes required an additional gas tamponade or any other procedure in the early postoperative period due to hypotony. A total of 13 (3.7%) eyes were reoperated for recurrent vitreous hemorrhage; 23 (6.5%) eyes were reoperated on a second time, nine (2.5%) a third time, and 1 (0.2%) a fourth time for recurrent rhegmatogenous retinal detachment. Postoperative fibrinoid reaction was seen in 17 (4.8%) eyes on the first day and responded well to the medications. Cataract development was found in 61 (22.5%) of the 270 phakic eyes after a mean duration of 6.4 ± 3.5 months. Anatomical success was obtained in 86% of the patients and functional success in 72%. Conclusion: The 23G transconjunctival vitrectomy system is safe and effective in a wide field of vitreoretinal conditions. It is a good alternative to 20G and 25G techniques but needs some improvement mainly in regards to the instruments and related techniques; further larger controlled group studies are needed.
Outcomes of Transconjunctival Sutureless 25-GAUGE Vitrectomy with Silicone Oil Infusion
Retina, 2007
Purpose: To evaluate the outcomes and complications of surgical management with 25-gauge pars plana vitrectomy (PPV) and silicone oil (SO) tamponade in complex vitreoretinal diseases. Methods: Retrospective review of a consecutive, interventional case series at a single center. Results: Thirty-five eyes of 35 patients were included in the study. The indications for vitrectomy included tractional retinal detachment (11 eyes), macular hole (6 eyes), proliferative vitreoretinopathy or recurrent retinal detachment (9 eyes), neovascular glaucoma (3 eyes), giant retinal tear (3 eyes), and pathologic myopia with epiretinal membrane or macular hole (3 eyes). All patients underwent 25-gauge PPV with either 1,000-centistoke (n ϭ 31) or 5,000-centistoke (n ϭ 4) SO tamponade infused through a 24-gauge angiocatheter. No intraoperative complications were noted. The median preoperative visual acuity was counting fingers (range, 20/50 to light perception). The median postoperative visual acuity after a median follow-up of 6 months (range, 1-19 months) was 20/200 (range, 20/30 to light perception). A small subconjunctival SO bleb was identified in two patients. Recurrent retinal detachment occurred in three patients. No significant complications relating to the use of SO in the setting of 25-gauge PPV occurred. Conclusions: Advances in 25-gauge PPV instrumentation have enabled expanding indications for 25-gauge PPV. 25-Gauge PPV with SO tamponade is safe and efficient and can be considered in the surgical management of complex vitreoretinal disease.
Pakistan journal of medical sciences
To compare effectiveness of releasable transconjunctival sutures in 23 gauge vitrectomy and standard 20 gauge vitrectomy. This prospective comparative study was conducted in Department of Vitreoretinal Surgery, Al Ehsan Eye Hospital, Lahore from June 2016 to March 2017. It included 84 patients in total (Group-A: 42 patients underwent 23 gauge releasable suture vitrectomy; Group-B: 42 patients who underwent standard 20 gauge vitrectomy). Pre operative and post operative best corrected visual acuity, surgical duration, pre and post operative intraocular pressure and complication profile was compared between two groups. The leading cause for vitrectomy was vitreous haemorrhage. (Group-A; n=15 ;35.71%; Group-B; n=17; 40.47%). There was statistically significant improvement in preoperative and postoperative BCVA in both groups (Group A: P-value < 0.05; Group B P-value < 0.05) but there was no significant difference in post operative BCVA between two groups at 3 months (P-value >...
Twenty-five gauge vitrectomy in uveitis
Arquivos Brasileiros de Oftalmologia, 2012
To evaluate anatomical and functional results of 25gauge transconjunc tival sutureless pars plana vitrectomy in patients with uveitis. Methods: Vitrectomy was performed on 20 eyes with residual vitritis secondary to in fectious and noninfectious uveitis. Patients were evaluated 1 week before surgery and after surgery at day 1, week 1, week 4 and week 12. Visual acuity (VA), intraocular pressure, anterior chamber cells and flare and vitreous haze were measured. Results: Mean VA improved from 2.06 ± 0.94 logMAR before surgery to 0.58 ± 0.46 logMAR at week 12 (p<0.05). No case required conversion to standard 20gauge instrumentation or suture placement, no intraoperative complications were noted. Transient postoperative hypotony was seen in three eyes. One patient with toxoplasmic retinochoroiditis had a relapse during followup. Conclusion: 25gauge vitrectomy has proven its efficacy on cleansing vitreous opa cities and improving visual acuity on patients with residual vitritis secondary to uveitis with minimal postoperative inflammation and complications.
Comparison of outcomes between 20, 23 and 25 gauge vitrectomy for idiopathic macular hole
International Journal of Retina and Vitreous, 2015
Purpose: To compare the results of 20, 23, 25 gauge pars plana vitrectomy (PPV) with two different gas tamponades for idiopathic macular hole (MH) in a multi-surgeon vitroretinal practice. Methods: In this comparative, retrospective, interventional case series, the medical charts of 142 eyes/130 patients were reviewed. Patients who matched our inclusion criteria: eye with stage 2, 3, or 4 MH that underwent 20, 23, or 25 gauge PPV, internal limiting membrane (ILM) peeling, and fluid-gas exchange from January, 2005 to May, 2012 and had at least 6 months follow-up. The best current corrected visual acuity (VA) and anatomical status of the MH were assessed by optical coherent tomography (OCT) at 6 months, 1 year, and 2 years after vitrectomy. Results: The MH closed successfully after primary vitrectomy in 86.5 % (20 gauge), 96.4 % (23 gauge), and 92 % (25 gauge). Preoperative VA median were 20\126 (20 gauge), 20\100 (23 gauge), and 20\80 (25 gauge). At 6 months and 2 years postoperative VA did not differ significantly between the 3 groups (p = 0.570, and 0.054 respectively). However, at 12 months postoperative VA median 20\60 (20 gauge), 20\69 (23 gauge), and 20\40 (25 gauge) differ significantly (p = 0.005) likely due to cataract changes. The final median postoperative VA (at 2 years) in 25 gauge PPV group was 20/40 which was better than final visual outcomes for 20, and 23 gauge PPV groups (20/50, and 20/55 respectively). The different was not a statistically significant. MH closed successfully in 96 % (C3F8), and 88.1 % (SF6) (p = 0.063). Preoperative median VA was 20/100 in both groups of gas. At 6 months, 1 year, and 2 years postoperative median VAs did not differ significant between the 2 groups (p = 0.076, 0.343, and 0.309 respectively). MH closed successfully in (96.9 %) 12-14 % C3F8, and (95.3 %) 15-16 % C3F8 (p = 0.611). MH closed in (82.1 %) 18-20 % SF6, and (96.4 %) 22-26 % SF6 (p=0.053). Conclusion: Based on the results of this study, 20, 23, and 25 gauge of PPV have similar MH closure rates and VA outcomes. SF6 at 22-26 % or C3F8 at 12-14 % achieved maximum closure rates.