Original article
23- and 20-Gauge Vitrectomy with Air Tamponade with Combined Phacoemulsification for Idiopathic Macular Hole: A Single-Surgeon Study

https://doi.org/10.1016/j.ajo.2011.01.015Get rights and content

Purpose

To compare the results of 23- and 20-gauge vitrectomies combined with phacoemulsification and aspiration and intraocular lens implantation (phacoemulsification surgery) 1 year after repair of idiopathic macular holes.

Design

Retrospective, consecutive, comparative case series.

Methods

The medical charts of 100 consecutive eyes were reviewed that had undergone either 23- or 20-gauge vitrectomy combined with phacoemulsification surgery to treat an idiopathic macular hole performed by 1 surgeon. The rate of improvement of the logarithm of the minimal angle of resolution visual acuity (VA) was calculated using the formula: (postoperative value − preoperative value) × 100/(1-year postoperative value − preoperative value).

Results

The macular holes closed successfully after the primary vitrectomy in all eyes in both groups. Although the VAs did not differ significantly before surgery or 1 year after surgery between the 2 groups, the VA improvement was significantly greater 1 and 3 months after surgery (P = .02, for both) in the 23-gauge group compared with the 20-gauge group. The induced corneal astigmatism levels 1 week and 1 and 3 months after surgery were significantly lower (P = .01, P = .01, and P = .03, respectively) and the surgical time was significantly shorter (P = .01) in the 23-gauge group than in the 20-gauge group. No apparent complications developed in either group.

Conclusions

Since 23-gauge vitrectomy combined with phacoemulsification surgery is advantageous because the VA improved rapidly after treating the macular holes with an acceptable safety profile, idiopathic macular holes are a good indication for 23-gauge vitrectomy combined with phacoemulsification surgery.

Section snippets

Methods

We retrospectively reviewed 50 eyes of 47 consecutive patients with an idiopathic macular hole who underwent 20-gauge vitrectomy combined with phacoemulsification surgery and 50 eyes of 48 consecutive patients with the disorder who underwent 23-gauge vitrectomy combined with phacoemulsification surgery performed by the same surgeon (T.H.), who was experienced with both vitreous and phacoemulsification surgeries (Table). Twenty-gauge vitrectomies were performed from April 2004 through June 2006,

Results

The Table shows the demographic and baseline characteristics of the eyes in the 2 study groups. No significant differences were found among the preoperative characteristics between the 2 groups.

A posterior vitreous detachment was created during surgery in 38 (76%) eyes in the 23-gauge group and 37 (74%) eyes in the 20-gauge group. Retinal breaks associated with the maneuvers performed to create a posterior vitreous detachment developed in 6 (16%) of 38 eyes and ion 7 (19%) of 37 eyes in the 23-

Discussion

In the current study, less surgically induced corneal astigmatism developed 3 months after surgery in eyes that underwent 23-gauge vitrectomy to repair idiopathic macular holes compared with the eyes treated with 20-gauge vitrectomy. The improvement in the VA 1 and 3 months after surgery was greater, and the VAs 1 and 3 months after surgery were better in the 23-gauge group. However, no significant difference was found in VA 1 year after surgery between the 2 groups.

We previously reported rapid

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, MA. His primary areas of interest are vitreoretinal disorders and vitreous surgery.

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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, MA. His primary areas of interest are vitreoretinal disorders and vitreous surgery.

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