Original Paper
Ophthalmologica
Ophthalmologica 2015;233:104–111 DOI: 10.1159/000369258
Received: July 31, 2014 Accepted after revision: October 17, 2014 Published online: December 3, 2014
23-Gauge versus 25-Gauge Vitrectomy for Proliferative Diabetic Retinopathy: A Comparison of Surgical Outcomes Grant Guthrie a Henry Magill b David H.W. Steel c, d
d
Chelsea and Westminster Hospital, and b Royal Free Hospital, London, c Sunderland Eye Infirmary, Sunderland, and Institute of Genetic Medicine, University of Newcastle upon Tyne, Newcastle upon Tyne, UK
Key Words 23-Gauge vitrectomy · 25-Gauge vitrectomy · Vitrectomy · Proliferative diabetic retinopathy · Postoperative vitreous cavity haemorrhage · Diabetic vitrectomy
Abstract Purpose: This study compared clinical outcomes and complications between 23-gauge (23g) and 25-gauge (25g) transconjunctival sutureless vitrectomy in patients with proliferative diabetic retinopathy. Study Design: It was a retrospective study using data prospectively defined and collected. 80 eyes underwent 23g transconjunctival sutureless vitrectomy, and 80 eyes underwent 25g surgery using the same vitrectomy system by one surgeon. Primary outcome measures were best-corrected visual acuity, intraocular pressure (IOP), and incidence of intraoperative and postoperative complications. Results: Vision was significantly improved after intervention in both groups (p ≥ 0.0001). There was no significant difference in visual outcomes between the groups (p = 0.43) or in the type and frequency of retinal breaks occurring during surgery (p = 0.63). The 23g group had significantly more patients with a day 1 IOP of 3 weeks postoperatively). Eyes with previous vitrectomy surgery were excluded from the study. In 1 patient in the 23g group and in 2 patients in the 25g group silicone oil was used, and these were excluded from further analysis but are presented in table 5. The groups were compared using Minitab 16 (Minitab Ltd., Coventry, UK) for statistical analysis. Case characteristics were calculated using descriptive statistics, including mean and SD. Categorical variables were compared using Fisher’s exact test and Pearson’s χ2 test as appropriate. Means were compared using Student’s t test for unequal variance; p values of 0.0001 >0.0001
25g surgery
p
5 (6) 1 (1) 9 (12) 11 (14)
2 (3) 1 (1) 7 (9) 8 (10)
0.44 1.00 0.8 0.62
11 (14) 1 (1)
8 (10) 0 (0)
0.49 1.00
Figures in bold indicate significant p values.
Table 3. Intraoperative retinal breaks and gas use
23g surgery Peroperative retinal breaks, n (%) Posterior iatrogenic breaks Entry site breaks Other PVD-related tears Number of eyes with any new break Tamponade, n (%) SF6 Postoperative retinal detachment, n (%)
Small-Gauge Vitrectomy for Proliferative Diabetic Retinopathy
Ophthalmologica 2015;233:104–111 DOI: 10.1159/000369258
107
Downloaded by: Universitätsbibliothek Giessen 134.176.129.147 - 5/12/2015 5:40:17 PM
PVD = Posterior vitreous detachment.
Table 4. Adverse postoperative events
Table 5. Cases where silicone oil was used
Gauge
n
Adverse events
Silicone oil usage
n Description
25g
3
(1) One patient with a CRAO occurring 2 weeks postoperatively, HM vision at 1 year (2) One patient with a hyphema on the first day with raised IOP; this settled spontaneously with topical treatment and 6/18 visual outcome at 1 year (3) One patient with new iris rubeosis visible at 2 months postoperatively and raised IOP. Treated with posterior fill in PRP which resolved the rubeosis and normalized the IOP with no ongoing treatment. 6/36 visual acuity at 1 year
25g
2 (1) One patient with combined tractional and rhegmatogenous retinal detachment. Oil removal and laser at 6 months postoperatively. Visual acuity of count fingers at 10 months, patient then defaulted from follow-up and outcome at 1 year unknown (2) One patient with extensive subretinal haemorrhage and posterior retinal holes underlying a dense vitreous haemorrhage at the time of vitrectomy surgery. Oil removal at 2 months postoperatively and a visual acuity of count fingers at 12 months postoperatively
23g
1 Patient with extensive subretinal haemorrhage and dissection not fully completed with posterior retinal breaks. Surgery revised with oil removal 6 weeks later. Final visual acuity of count fingers with an attached retina at 14 months’ follow-up
3
(1) One patient with postoperative rubeosis with raised pressure treated with further posterior scatter laser and IOP returned to normal on topical treatment only. Visual acuity HM at 1 year despite clear vitreous cavity and attached retina (2) One patient with progressive postoperative ischaemia and final NPL visual outcome at 1 year with attached retina and clear vitreous cavity (3) One patient with an inferior tractional retinal detachment with PVR requiring inferior 180 retinotomy and heavy oil; oil removal 3 months later and 6/36 vision at 1 year
CRAO = Central retinal artery occlusion; HM = hand movements; PRP = panretinal photocoagulation; NPL = no perception of light.
ilarly, the frequency of cataract surgery following vitrectomy was equivalent. Eighteen (23%) eyes in the 23g group required at least one sclerostomy suture compared to only 6 (8%) eyes in the 25g group (p = 0.014). There was no significant difference between mean day 1 and day 14 IOPs, but there were significantly more patients with a day 1 IOP of
Ophthalmologica
Ophthalmologica 2015;233:104–111 DOI: 10.1159/000369258
Received: July 31, 2014 Accepted after revision: October 17, 2014 Published online: December 3, 2014
23-Gauge versus 25-Gauge Vitrectomy for Proliferative Diabetic Retinopathy: A Comparison of Surgical Outcomes Grant Guthrie a Henry Magill b David H.W. Steel c, d
d
Chelsea and Westminster Hospital, and b Royal Free Hospital, London, c Sunderland Eye Infirmary, Sunderland, and Institute of Genetic Medicine, University of Newcastle upon Tyne, Newcastle upon Tyne, UK
Key Words 23-Gauge vitrectomy · 25-Gauge vitrectomy · Vitrectomy · Proliferative diabetic retinopathy · Postoperative vitreous cavity haemorrhage · Diabetic vitrectomy
Abstract Purpose: This study compared clinical outcomes and complications between 23-gauge (23g) and 25-gauge (25g) transconjunctival sutureless vitrectomy in patients with proliferative diabetic retinopathy. Study Design: It was a retrospective study using data prospectively defined and collected. 80 eyes underwent 23g transconjunctival sutureless vitrectomy, and 80 eyes underwent 25g surgery using the same vitrectomy system by one surgeon. Primary outcome measures were best-corrected visual acuity, intraocular pressure (IOP), and incidence of intraoperative and postoperative complications. Results: Vision was significantly improved after intervention in both groups (p ≥ 0.0001). There was no significant difference in visual outcomes between the groups (p = 0.43) or in the type and frequency of retinal breaks occurring during surgery (p = 0.63). The 23g group had significantly more patients with a day 1 IOP of 3 weeks postoperatively). Eyes with previous vitrectomy surgery were excluded from the study. In 1 patient in the 23g group and in 2 patients in the 25g group silicone oil was used, and these were excluded from further analysis but are presented in table 5. The groups were compared using Minitab 16 (Minitab Ltd., Coventry, UK) for statistical analysis. Case characteristics were calculated using descriptive statistics, including mean and SD. Categorical variables were compared using Fisher’s exact test and Pearson’s χ2 test as appropriate. Means were compared using Student’s t test for unequal variance; p values of 0.0001 >0.0001
25g surgery
p
5 (6) 1 (1) 9 (12) 11 (14)
2 (3) 1 (1) 7 (9) 8 (10)
0.44 1.00 0.8 0.62
11 (14) 1 (1)
8 (10) 0 (0)
0.49 1.00
Figures in bold indicate significant p values.
Table 3. Intraoperative retinal breaks and gas use
23g surgery Peroperative retinal breaks, n (%) Posterior iatrogenic breaks Entry site breaks Other PVD-related tears Number of eyes with any new break Tamponade, n (%) SF6 Postoperative retinal detachment, n (%)
Small-Gauge Vitrectomy for Proliferative Diabetic Retinopathy
Ophthalmologica 2015;233:104–111 DOI: 10.1159/000369258
107
Downloaded by: Universitätsbibliothek Giessen 134.176.129.147 - 5/12/2015 5:40:17 PM
PVD = Posterior vitreous detachment.
Table 4. Adverse postoperative events
Table 5. Cases where silicone oil was used
Gauge
n
Adverse events
Silicone oil usage
n Description
25g
3
(1) One patient with a CRAO occurring 2 weeks postoperatively, HM vision at 1 year (2) One patient with a hyphema on the first day with raised IOP; this settled spontaneously with topical treatment and 6/18 visual outcome at 1 year (3) One patient with new iris rubeosis visible at 2 months postoperatively and raised IOP. Treated with posterior fill in PRP which resolved the rubeosis and normalized the IOP with no ongoing treatment. 6/36 visual acuity at 1 year
25g
2 (1) One patient with combined tractional and rhegmatogenous retinal detachment. Oil removal and laser at 6 months postoperatively. Visual acuity of count fingers at 10 months, patient then defaulted from follow-up and outcome at 1 year unknown (2) One patient with extensive subretinal haemorrhage and posterior retinal holes underlying a dense vitreous haemorrhage at the time of vitrectomy surgery. Oil removal at 2 months postoperatively and a visual acuity of count fingers at 12 months postoperatively
23g
1 Patient with extensive subretinal haemorrhage and dissection not fully completed with posterior retinal breaks. Surgery revised with oil removal 6 weeks later. Final visual acuity of count fingers with an attached retina at 14 months’ follow-up
3
(1) One patient with postoperative rubeosis with raised pressure treated with further posterior scatter laser and IOP returned to normal on topical treatment only. Visual acuity HM at 1 year despite clear vitreous cavity and attached retina (2) One patient with progressive postoperative ischaemia and final NPL visual outcome at 1 year with attached retina and clear vitreous cavity (3) One patient with an inferior tractional retinal detachment with PVR requiring inferior 180 retinotomy and heavy oil; oil removal 3 months later and 6/36 vision at 1 year
CRAO = Central retinal artery occlusion; HM = hand movements; PRP = panretinal photocoagulation; NPL = no perception of light.
ilarly, the frequency of cataract surgery following vitrectomy was equivalent. Eighteen (23%) eyes in the 23g group required at least one sclerostomy suture compared to only 6 (8%) eyes in the 25g group (p = 0.014). There was no significant difference between mean day 1 and day 14 IOPs, but there were significantly more patients with a day 1 IOP of
