25-Gauge sutureless vitrectomy versus 20-gauge vitrectomy for the repair of primary rhegmatogenous retinal detachment

• Published in: Retina (Philadelphia, Pa.) Vol. 29; no. 4; pp. 444 - 450
• Main Authors: Von Fricken, Manfred A, Kunjukunju, Nancy, Weber, Charles, Ko, George
• Format: Journal Article
• Language: English
• Published: United States 01-04-2009
• Subjects: Catheterization; Choroid - blood supply; Endophthalmitis - etiology; Equipment Design; Eyeglasses; Female; Follow-Up Studies; Hemorrhage - etiology; Humans; Intraocular Pressure; Male; Middle Aged; Postoperative Period; Retinal Detachment - etiology; Retinal Detachment - surgery; Retinal Perforations - complications; Retrospective Studies; Visual Acuity; Vitrectomy - adverse effects; Vitrectomy - instrumentation; Vitrectomy - methods; Vitreous Hemorrhage - etiology
• ISSN: 1539-2864
• DOI: 10.1097/IAE.0b013e318196b19c

To compare the anatomic and visual results and complications of 25-gauge transconjunctival sutureless vitrectomy versus conventional 20-gauge vitrectomy for the management of primary rhegmatogenous retinal detachment.
A retrospective comparative analysis of 125 consecutive eyes from 125 patients with a minimum of 3 months follow-up was performed. All patients underwent primary vitrectomy with complete fluid air exchange, gas tamponade, and laser retinopexy. Excluded were eyes with prior retinal or vitreous surgery, and patients with inadequate follow-up. Sixty-four patients underwent 25-gauge transconjunctival sutureless vitrectomy and 61 patients underwent 20-gauge pars plana vitrectomy from September 2004 to April 2007. Primary endpoints included one surgery retinal reattachment success rate, visual outcomes, postoperative intraocular pressures and complications as determined by standard clinical evaluation.
Baseline demographic and preoperative ocular characteristics showed no statistically significant difference between the two cohorts. The mean follow-up interval was 305.4 days for the 25-gauge group and 452.4 days for the 20-gauge group. The single operation success rate with one procedure was 58/64 (90.6%) for 25-gauge cases and 56/61 (91.8%) for 20-gauge cases, Fisher Exact Test (P = 0.801). All cases were attached at final follow-up and the anatomic success rate was 100% for each of the two cohorts. Preoperative best-corrected visual acuity (BCVA) was 20/125 and 20/169 for 25-gauge and 20-gauge cases, respectively (P > 0.5). The final follow-up mean BCVA was 20/34 and 20/36 for the 25-gauge and 20-gauge groups, respectively (P > 0.6). In the 25-gauge group two cases were complicated by hypotony that resolved uneventfully and one case developed postoperative choroidal and vitreous hemorrhage. In the 20-gauge group there was one case of sterile endophthalmitis and one case of vitreous hemorrhage.
There was no significant difference between 25-gauge transconjunctival sutureless vitrectomy and 20-gauge vitrectomy for the repair of primary rhegmatogenous retinal detachments.