Outcomes of 77 Consecutive Cases of 23-Gauge Transconjunctival Vitrectomy Surgery for Posterior Segment Disease
Received 8 June 2006; accepted 14 February 2007.
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.
1Vitreous, Retina, Macula Consultants of New York, New York, New York.
2LuEsther T. Mertz Retina Research Laboratory, Manhattan Eye, Ear, and Throat Hospital, New York, New York.
3Department of Ophthalmology, Hospital of Galdacano, Vizcaya, Spain.
Reprint requests to Richard F. Spaide, MD, Vitreous, Retina, Macula Consultants of New York, 460 Park Avenue, 5th Floor, New York, NY 10022.
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.
ABSTRACT