Original article
Comparison of One-year Outcomes between 23- and 20-gauge Vitrectomy for Preretinal Membrane

https://doi.org/10.1016/j.ajo.2008.10.009Get rights and content

Purpose

To compare the outcomes of transconjunctival sutureless 23-gauge vitrectomy and conventional 20-gauge vitrectomy 1 year after removal of preretinal membrane.

Design

Retrospective, consecutive, comparative case series.

Methods

One hundred consecutive eyes with a preretinal membrane underwent either 23- and 20-gauge vitrectomy. The rate of improvement of the logarithm minimum angle of resolution visual acuity (VA) was calculated by the formula: (various postoperative values − preoperative values) × 100/ (1 year postoperative values − preoperative values).

Results

No significant differences were found between the groups in the preoperative and postoperative VAs. The VA improvement was higher and the surgically induced corneal astigmatism was lower 1 week postoperatively in the 23-gauge group compared with the 20-gauge group (P = .006 and P = .001, respectively). The flare values in the anterior chamber measured by laser flare meter preoperatively and 1 week postoperatively did not differ between the groups. The surgical time was significantly (P = .023) shorter in the 23-gauge group than in the 20-gauge group. No apparent complications developed in either group.

Conclusion

Transconjunctival sutureless 23-gauge vitrectomy appears effective for preretinal membrane surgery with an acceptable safety profile. Transconjunctival sutureless 23-gauge vitrectomy may be a treatment option for preretinal membranes.

Section snippets

Patients and Methods

We retrospectively reviewed 50 eyes of 47 consecutive patients with a preretinal membrane who underwent 20-gauge vitrectomy combined with phacoemulsification and aspiration (PEA) and intraocular lens (IOL) implantation and 50 eyes of 46 consecutive patients with the disorder who underwent 23-gauge vitrectomy combined with PEA and IOL implantation by the same surgeon (T.H.) (Table). The 20-gauge vitrectomies were performed from March 1, 2005 to June 30, 2006, and the 23-gauge vitrectomies were

Results

No patient required a suture at the 23-gauge sclerotomy site because of leakage and no sclerotomies were converted to the 20-gauge procedure.

A PVD was created intraoperatively in 17 (34%) of 50 eyes in the 23-gauge group and 15 (30%) in the 20-gauge group. Retinal breaks associated with the maneuvers performed to create a PVD occurred in 4 (24%) of 17 and 3 (20%) of 15 eyes in the 23- and 20-gauge groups, respectively, and were treated effectively with photocoagulation intraoperatively. No

Discussion

In the current study, there was rapid VA improvement and less surgically induced corneal astigmatism 1 week postoperatively in the eyes that underwent 23-gauge vitrectomy to remove preretinal membranes compared with the eyes treated with 20-gauge vitrectomy. Less induced corneal astigmatism during the first postoperative month may accelerate the improvement in VA.9, 10 The increase in postoperative astigmatism may be attributed to suturing at the entry port, and astigmatic changes after

Taiichi Hikichi, MD, PhD, has been a chief doctor of the ward of Ohtsuka Eye Hospital, Sapporo, Japan, since 2004. He received his MD and PhD from Asahikawa Medical College, Asahikawa, Japan. From 1992 to 1994, Dr Hikichi was a fellow at the Schepens Eye Research Institute, Department of Ophthalmology, Harvard Medical School, and Schepens Retina Associates, Boston, Massachusetts. His primary areas of interest are vitreoretinal disorders and vitreous surgery.

References (19)

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Taiichi Hikichi, MD, PhD, has been a chief doctor of the ward of Ohtsuka Eye Hospital, Sapporo, Japan, since 2004. He received his MD and PhD from Asahikawa Medical College, Asahikawa, Japan. From 1992 to 1994, Dr Hikichi was a fellow at the Schepens Eye Research Institute, Department of Ophthalmology, Harvard Medical School, and Schepens Retina Associates, Boston, Massachusetts. His primary areas of interest are vitreoretinal disorders and vitreous surgery.

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