The 23-Gauge Sutureless Vitreoretinal Surgery in Previously Vitrectomized Eyes

Kwang Hoon Shin; Dae Yeong Lee; Hee Jin Sohn; Dong Heun Nam

doi:10.3341/jkos.2010.51.5.716

Journal List > J Korean Ophthalmol Soc > v.51(5) > 1008814

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Shin, Lee, Sohn, and Nam: The 23-Gauge Sutureless Vitreoretinal Surgery in Previously Vitrectomized Eyes

Original Article

J Korean Ophthalmol Soc 2010;51(5):716-720.

Published online: 25 September 2010

DOI: https://doi.org/10.3341/jkos.2010.51.5.716

The 23-Gauge Sutureless Vitreoretinal Surgery in Previously Vitrectomized Eyes

Kwang Hoon Shin, MD, Dae Yeong Lee, MD, Hee Jin Sohn, MD, Dong Heun Nam, MD, PhD

Department of Ophthalmology, Gachon University Gil Hospital, Incheon, Korea

Address reprint requests to Dong Heun Nam, MD, PhD Department of Ophthalmology, Gachon University Gil Hospital #1198 Guwol-dong, Namdong-gu, Incheon 405-760, Korea Tel: 82-32-460-3364, Fax: 82-32-460-3358, E-mail: eyedawns@gilhospital.com

Received 26 November 2009 Accepted 4 March 2010

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To investigate the incidence and risk factors of major complications including postoperative hypotony after 23-gauge transconjunctival sutureless vitrectomy in previously vitrectomized eyes.

Methods

The authors retrospectively reviewed medical records of 52 eyes, which underwent 23-gauge transconjunctival sutureless vitrectomy of previously vitrectomized eyes by a single surgeon. Major outcomes were postoperative hypotomy (＜6 mmHg), intraoperative sclera shrinkage during sclerotomy, and other postoperative complications. Multiple logistic regression analysis was performed that included 212 eyes with primary vitreoretinal surgery in order to validate secondary vitreoretinal surgery as a significant risk factor of postoperative hypotony.

Results

Postoperative hypotony occurred in 4 eyes (7.7%) out of 52 eyes that underwent a second vitrectomy. The odds ratio of the second vitreoretinal surgery (OR=1.15, p=0.283) was not significant by multiple logistic regression analysis that included age, sex, axial length of globe, and the number of surgeries as the independent variables. Choroidal detachment occurred in one eye but disappeared three days later. The intraocular pressure was normalized within one week in all cases. Scleral shrinkage during sclerotomy occurred in five eyes (9.6%), and there were no other major complications, such as endophthalmitis. Conclusions: A 23-gauge transconjunctival sutureless vitrecomy of previously vitrectomized eyesshowed a 7.7% incidence of postoperative hypotony and favorable prognosis.

Keywords: 23-gauge transconjunctival sutureless vitrectomy, Postoperative hypotony, Vitrectomized eye

References

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Table 1.

Distribution of Cases

Number of patients (eyes)	48(52)
Age (years)	54.9±15.7
Gender (male:female)	23:29
Laterality (right:left)	20:32
Lens status (phakic:pseudophakic: aphakic)	22:25:5
Axial length (mm)	23.65±1.90
Follow-up duration (days)	164.4±109.6
Preoperative IOP (mm Hg)	13.46±3.33
Indicaions of second vitroretinal surgery
Rhegmatogenous RD	10 (19.2%)
Epiretinal membrane	5 (9.6%)
Tractional RD	3 (5.8%)
Macular hole	1 (1.9%)
Endophthalmitis	1 (1.9%)
Emulsified silicone oil removal	32 (61.5%)

IOP=intraocular pressure.

Table 2.

Tamponade material

	Number of eyes (%)
Balanced Salt Solution	3 (5.8%)
Partial Air	22 (42.3%)
Full Air	5 (9.6%)
Gas (C3F8)	9 (17.3%)
Silicone Oil	12 (23.1%)
Total	52 (100.0%)

Table 3.

Clinical data of the patients who experienced postoperative hypotony (< 6 mmHg)

	Case 1	Case 2	Case 3	Case 4
Diagnosis	PDR c TRD	RRD	PDR c TRD	PDR c TRD
Age (years)	46	15	36	55
Sex	M	M	F	M
Axial length (mm)	25.31	23.88	27.25	25.74
Tamponade material	Silicone oil	Silicone oil	Partial air	Partial air
Preoperative IOP (mm Hg)	9	8	15	12
Postoperative IOP (mm Hg)
Day 1	4	5	5	2
Day 3	5	9	10	10
Day 7	10	14	12	8
Another complications				Choroidal datachment

PDR=proliferative diabetic retinopathy; TRD=tractional retinal detachment; RRD=rhegmatogenous retinal detachment.

Table 4.

Multivariate analysis for associations between risk factors and postoperative hypotony after transconjunctival sutureless vitrectomy (N=264)

Variables	OR	95% CI	P
Prior vitrectomy	1.15	0.13–1.75	0.283
Young age (<50yrs)	8.61	3.2–14.1	0.003^*
Male gender	0.66	0.17–2.09	0.415
Long axial length (≥25 mm)	6.47	1.53–16.65	0.011^*

^* Statistically significant.

Table 5.

Clinical data of the patients who experienced scleral collapse during making sclerotomy

	Case 1	Case 2	Case 3	Case 4	Case 5
Diagnosis	RRD	PDR with TRD	PDR with VH	PDR with TRD	RRD
Age (years)	53	33	62	52	50
Sex	F	M	F	F	M
Axial length (mm)	24.20	23.72	22.04	22.87	22.68
Preoperative IOP (mm Hg)	12	13	12	14	10
Postoperative IOP (mm Hg)
Day 1	14	19	8	12	9
Day 3	12	13	10	15	11
Day 7	7	12	17	16	10

IOP=intraocular pressure; RRD=rhegmatogenous retinal detachment; TRD=tractional retinal detachment; PDR=proliferative diabetic retinopathy; VH=vitreous hemorrhage.

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