Primary vitrectomy for rhegmatogenous retinal detachment in pseudophakic eyes: 20‐gauge versus 25‐gauge vitrectomy

• Published in: Acta ophthalmologica (Oxford, England) Vol. 94; no. 8; pp. 824 - 828
• Main Authors: Süsskind, Daniela, Neuhann, Irmingard, Hilgers, Ralf‐Dieter, Hagemann, Ulrike, Szurman, Peter, Bartz‐Schmidt, Karl Ulrich, Aisenbrey, Sabine
• Format: Journal Article
• Language: English
• Published: England Wiley Subscription Services, Inc 01-12-2016
• Subjects: 25‐gauge vitrectomy; Acuity; Aged; Female; Functional anatomy; Humans; Intraocular pressure; Intraocular Pressure - physiology; Male; Microsurgery - methods; Middle Aged; Ophthalmology; pars plana vitrectomy; Postoperative Complications; Pressure; Prospective Studies; Pseudophakia - physiopathology; Pseudophakia - surgery; pseudophakic; Retina; retinal detachment; Retinal Detachment - physiopathology; Retinal Detachment - surgery; Success; Surgery; transconjunctival sutureless vitrectomy; Visual acuity; Visual Acuity - physiology; Vitrectomy - methods; pars plana vitrectomy; transconjunctival sutureless vitrectomy; retinal detachment; 25-gauge vitrectomy; pseudophakic
• ISSN: 1755-375X; 1755-3768
• DOI: 10.1111/aos.13133

Purpose
To report anatomical and functional outcome of 20‐gauge versus 25‐gauge primary pars plana vitrectomy for management of complex rhegmatogenous retinal detachment in pseudophakic eyes.
Methods
Prospective single‐centre randomized comparative pilot trial. Fifty patients with retinal detachment (RD) not complicated by proliferative vitreoretinopathy grade B or C, who cannot be treated with a single meridional sponge, were randomized (1:1) from November 2006 to January 2010 to either 20‐gauge or 25‐gauge vitrectomy as first surgical intervention and followed up over a 12‐month period, evaluating change in best‐corrected visual acuity, anatomical success and intraocular pressure dysregulation.
Results
Mean visual acuity improved by 0.88 (SD 0.67) from 1.22 logMAR (SD 0.63) to 0.34 logMAR (SD 0.31) in the 20‐gauge group and by 0.53 (SD 0.91) from 0.86 logMAR (SD 0.73) to 0.34 logMAR (SD 0.46) in the 25‐gauge group. Final anatomical success rate was 100% and primary success rate was 69% at 6 months of follow‐up. In the 20‐gauge group, the retina was attached after one single procedure in 18 eyes (72%) and in 21 eyes (84%) of the 25‐gauge group. Two patients in the 25‐gauge group had hypotony at the first postoperative day which normalized within 6 weeks.
Conclusion
In our series, transconjunctival sutureless 25‐gauge and 20‐gauge vitrectomy showed comparable results in pseudophakic RD not suitable for single sponge surgery with respect to visual outcome and retinal reattachment. Postoperative hypotony does not seem to be a significant problem of transconjunctival sutureless vitrectomy.