Journal List > J Korean Ophthalmol Soc > v.50(3) > 1008498

Shin, Lee, and Oum: Comparison Between 20-Gauge and 23-Gauge Vitrectomy System in Primary Vitrectomy for Rhegmatogenous Retinal Detachment

Abstract

Purpose

The efficacy of 20-gauge and 23-gauge vitrectomy system was investigated in primary vitrectomy for rhegmatogenous retinal detachment.

Methods

Eyes that underwent primary vitrectomy without scleral buckling for the treatment of rhegmatogenous retinal detachment were followed up at least 6 months and were reviewed retrospectively. Anatomic results, functional outcomes, operation time and complications were compared between 20-gauge and 23-gauge groups.

Results

Among 59 eyes of 59 patients, the 20-gauge group had 29 eyes of 29 patients and 23-gauge group had 30 eyes of 30 patients. Anatomic success after a single operation was obtained in 23 eyes (79.3%) of the 20-gauge group and 28 eyes (93.3%) of the 23-gauge group. Recurrence occurred in 6 eyes (20.7%) in the 20-gauge and in 2 eyes (6.6%) in the 23-gauge group. Retinal reattachment in all of these eyes was obtained through reoperation. Visual acuity improved logMAR 0.2 or more in 19 eyes (65.5%) of the 20-gauge group and 20 eyes (66.7%) of the 23 gauge group (p=0.153, 0.215). The average operation time of the 23-gauge group was 80.2 minutes, which was significantly shorter than the 94.8 minutes of the 20-gauge group (p=0.008). Transient ocular hypertension and progression of lens opacity were the most common complications in the both groups.

Conclusions

Twenty-three-gauge transconjuctival sutureless vitrectomy achieved outcomes comparable with 20-gauge vitrectomy, with significantly shorter operation time in repair of rhegmatogenous retinal detachment. It is considered as a viable alternative to 20-gauge vitrectomy in selected cases.

References

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Table 1.
Baseline characteristics of the patients
Variables 20 Gauge 23 Gauge
No. of eyes (patients) 29 (29) 30 (30)
Age (years, mean) 58.7±13.0 59.8±9.21
Sex (male/female) 19/10 15/15
Preoperative visual acuity (logMAR, mean± SD*) 1.37±1.16 1.41±1.19
Duration of symptoms (weeks, mean) 3.27±3.98 3.33±4.35
Preoperative lens status (No. of eyes)    
 phakia 22 24
 pseudophakia 6 5
 aphakia 1 1
High Myopia (No. of eyes) 4 2
Follow-up (months, mean) 14.6±8.2 7.8±2.2

*SD=standard deviation.

Table 2.
Clinical aspects of breaks and detachment
Status No. of eyes (%) p
20 Gauge 23 Gauge
Multiple breaks 13 (44.8) 10 (33.3) 0.14
Large breaks (>3 DD*) 5 (17.2) 7 (23.3) 0.22
Posterior breaks 8 (27.6) 4 (13.3) 0.11
Vitreous hemorrhage 7 (24.1) 7 (23.3) 0.24
Macular off detachment 14 (48.3) 18 (60.0) 0.14
Detachment of 3 quadrants or more 4 (13.8) 7 (23.3) 0.17
Preoperative PVR   1 (3.3) 0.51

*DD=disc diameter

PVR=proliferative vitreoretinopathy.

Table 3.
Primary operation procedure
Methods No. of eyes (%) p
20 Gauge 23 Gauge
Combined cataract operation 13/22 (59.1) 23/24 (95.8) 0.003
Drainage retinotomy 6 (20.1) 5 (16.7) 0.24
Intraoperative PFCL 2 (7.9) 4 (13.3) 0.25
Tamponade      
 SF6 20 (69.0) 19 (63.3) 0.19
 C3 F8 9 (31.0) 10 (33.3) 0.21
Silicone oil 0 1 (3.3) 0.51
Table 4.
Comparison of the operation time between 20G and 23G vitrectomy
Time (minutes) 20 Gauge 23 Gauge p
Operation time (total) 94.8 80.2 0.008
with cataract operation 101.0 83.5 0.04
without cataract operation 89.7 69.3 NA*

*NA=not available.

Table 5.
Success and recurrence rate after primary vitrectomy for noncomplicated rhegmatogenous retinal detachment
  No. of eyes (%) p
20 Gauge 23 Gauge
Single operation* 23 (79.3) 28 (93.3) 0.09
Recurrence 6 (20.7) 2 (6.6) 0.07
Causes      
 New break 5 2 0.74
 PVR 1 0 0.74
Final operation 29 (100.0) 30 (100.0)  

*Single operation=anatomical success after the first vitrectomy

Final operation=anatomical success after the final operation.

Table 6.
Best corrected visual acuity and number of eyes showed visual acuity improvement more than 0.2
Duration BCVA (logMAR)   BCVA improvement, No. of eyes (%)  
20 Gauge 23 Gauge   20 Gauge 23 Gauge  
Mean± SD* p More than 0.2 (logMAR) p
Preoperative 1.37±1.16 1.41±1.19 0.876      
1 month 0.68±0.55 0.73±0.64 0.767 13 (44.8) 18 (60.0) 0.106
3 months 0.48±0.39 0.54±0.48 0.591 15 (51.7) 18 (60.0) 0.169
6 months 0.48±0.53 0.33±0.29 0.196 18 (62.1) 21 (70.0) 0.177
Final 0.25±0.29 0.27±0.27 0.772 19 (65.5) 22 (73.3) 0.181

*SD=standard deviation

BCVA=best corrected visual acuity.

Table 7.
Postoperative complications
Complications No. of cases (%)
20 Gauge 23 Gauge p
Cataract progression 5/9 (55.6) 0/1 (0.0) 0.50
Transient feathery PSC* 1/9 (11.1) 0/0 0.99
Transient ocular HTN 10 (34.4) 10 (33.3) 0.22
IOL decentration 1/19 (5.3) 2/28 (7.1)  
Hypotony 1 (3.4) 0 (0.0) 0.49
Glaucoma 0 (0.0) 3 (10.0) 0.12
Iatrogenic tear 3 (10.3) 3 (10.0) 0.33
ERM 1 (3.4) 2 (6.7) 0.39

*PSC=posterior subcapsular opacity

HTN=hypertension

ERM=epiretinal membrane.

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