Elsevier

Ophthalmology

Volume 114, Issue 6, June 2007, Pages 1197-1200.e3
Ophthalmology

Original Article
Outcomes of 77 Consecutive Cases of 23-Gauge Transconjunctival Vitrectomy Surgery for Posterior Segment Disease

https://doi.org/10.1016/j.ophtha.2007.02.020Get rights and content

Purpose

To describe the initial experience, effectiveness, and safety profile of 23-gauge instrumentation for a variety of vitreoretinal conditions.

Design

Single-center, retrospective, noncomparative, consecutive interventional case series.

Participants

Seventy-seven eyes of consecutive patients who underwent 23-gauge transconjunctival vitrectomy surgery by a single surgeon at the Manhattan Eye, Ear, and Throat Hospital from October 2004 through October 2005.

Intervention

All patients underwent 3-port 23-gauge vitrectomy using Dutch Ophthalmic Research Corporation instrumentation and an Alcon Accuris Vitrector.

Main Outcome Measures

Postoperative visual acuity at months 1 and 3, intraoperative and postoperative complications, and operative time.

Results

Mean acuity improved from 20/190 at baseline to 20/108 (P<0.0001) and 20/74 (P<0.0001) at months 1 and 3, respectively. By diagnosis, patients with epiretinal membrane (n = 20) improved from 20/124 to 20/93 (P = 0.0046), macular hole (n = 18) from 20/174 to 20/57 (P = 0.0007), rhegmatogenous retinal detachment (RD) (n = 14) from 20/248 to 20/51 (P = 0.0004), tractional RD (n = 12) from 20/175 to 20/62 (P = 0.0159), nonclearing vitreous hemorrhage (n = 12) from 20/1345 to 20/189 (P = 0.0004), vitreomacular traction (n = 4) from 20/145 to 20/124 (P = 0.7525), and retained lens fragments (n = 4) from 20/308 to 20/140 (P = 0.0972). One patient who underwent diagnostic vitrectomy had stable 20/50 acuity. Two patients had hypotony on postoperative day 1, 1 patient required a sutured sclerotomy intraoperatively, and no patients developed choroidal effusions. No intraoperative tears were noted. Surgical times collected on 17 patients during the final month of the study demonstrated a mean opening time (range) of 103 seconds (70–162), mean closing time of 75 seconds (17–470), and net operating time of 24.1 minutes (7.1–74.6).

Conclusions

Twenty-three–gauge instrumentation is effective for a variety of vitreoretinal surgical indications. The safety profile compared favorably with published rates for 25-gauge systems.

Section snippets

Materials and Methods

Approval was obtained from the Lenox Hill Hospital institutional review board for this study. All subjects signed an informed consent document before surgery. All surgical cases performed by a single surgeon (RFS) at a single site from October 2004 through October 2005 were included. Data abstracted from these consecutive charts included patient age, date of operation, indication for surgery, operative eye, visual acuity (VA) (preoperative visit, postoperative day 1, monthly postoperative

Results

All 77 patients (39 female, 38 male) were followed for a minimum of 3 months, or additional information was obtained from the referring physician in cases with <3 months’ follow-up. Mean follow-up time (± standard deviation) was 244±125 days. There were 42 right and 35 left eyes in this group. Indications for surgery (number of eyes) were epiretinal membrane (20), macular hole (18), rhegmatogenous RD (14), tractional RD (12), vitreomacular traction (4), retained lens fragments (4), nonclearing

Discussion

Twenty-three–gauge vitrectomy systems were introduced to provide sutureless transconjunctival surgery similar to that of 25-gauge systems, but with instrument functionality and stiffness that more closely mirror traditional 20-gauge systems. The sclerotomy wound is constructed in a manner different from that of either 20- or 25-gauge, which typically enters the eye normal to the scleral surface, producing a full-thickness hole in the sclera. In 20-gauge surgery, the hole is so large that it

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Manuscript no. 2006-618.

No authors have any proprietary interests in any of the devices mentioned in the article. The work was supported in part by a Heed Foundation (Cleveland, Ohio) Fellowship (to HFF) and a grant from the Macula Foundation, Inc., New York, New York.

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