Journal List > J Korean Ophthalmol Soc > v.50(7) > 1008311

Ku, Sohn, Lee, and Nam: Sclerotomy-related Retinal Breaks in Vitrectomy for Proliferative Diabetic Retinopathy: 20- vs 23-Gauge Systems

Abstract

Purpose

To compare the rate of intraoperative sclerotomy-related retinal breaks (SRRB) between 20- and 23-gauge vitrectomy for proliferative diabetic retinopathy (PDR).

Methods

Medical records of 62 consecutive eyes of 54 patients who underwent 20-gauge pars plana vitrectomy (PPV) and 63 consecutive eyes of 55 patients who received 23-gauge transconjunctival sutureless vitrectomy were retrospectively reviewed.

Results

Three (4.8%) out of 62 eyes in the 20-gauge group had SRRB and 1 (1.6%) eye developed retinal detachment at 4 months postoperatively, while 2 (3.2%) out of 63 eyes in the 23-gauge group had SRRB and 1 (1.6%) eye developed retinal detachment at 3 months postoperatively.

Conclusions

There were no significant differences in the rates of sclerotomy-related retinal breaks and sclerotomy-related retinal detachments between 20-gauge PPV and 23-gauge PPV for PDR.

References

1. Carter JB, Michels RG, Glaser BM, De Bustros S. Iatrogenic retinal breaks complicating pars plana vitrectomy. Ophthalmology. 1990; 97:848–53.
crossref
2. Sjaarda RN, Glaser BM, Thompson JT, et al. Distribution of iatrogenic retinal breaks in macular hole surgery. Ophthalmology. 1995; 102:1387–92.
crossref
3. Al-Harthi E, Abboud EB, Al-Dhibi H, Dhindsa H. Incidence of sclerotomy-related retinal breaks. Retina. 2005; 25:281–4.
crossref
4. Tognetto D, di Lauro MT, Fanni D, et al. Iatrogenic retinal traumas in ophthalmic surgery. Graefes Arch Clin Exp Ophthalmol. 2008; 246:1361–72.
crossref
5. Singh DV, Pal N, Azad RV. Incidence of early and late sclerotomy-related retinal breaks in patients who underwent pars plana vitrectomy. Retina. 2006; 26:251.
6. Scartozzi R, Bessa AS, Gupta OP, Regillo CD. Intraoperative sclerotomy-related retinal breaks for macular surgery, 20-vs 25-gauge vitrectomy systems. Am J Ophthalmol. 2007; 143:155–6.
7. Sabti K, Kapusta M, Mansour M, et al. Ultrasound biomicroscopy of sclerotomy sites: the effect of vitreous shaving around sclerotomy sites during pars plana vitrectomy. Retina. 2001; 21:464–8.
8. Territo C, Gieser JP, Wilson CA, Anand R. Influence of the cannulated vitrectomy system on the occurrence of iatrogenic sclerotomy retinal tears. Retina. 1997; 17:430–3.
crossref
9. Eckardt C. Transconjunctival sutureless 23-gauge vitrectomy. Retina. 2005; 25:208–11.
crossref
10. Wimpissinger B, Binder S. Entry-site-related retinal detachment after pars plana vitrectomy. Acta Ophthalmol Scand. 2007; 85:782–5.
crossref
11. Theocharis IP, Alexandridou A, Gili NJ, Tomic Z. Combined phacoemulsification and pars plana vitrectomy for macular hole treatment. Acta Ophthalmol Scand. 2005; 83:172–5.
crossref

Figure 1.
23-gauge microcannula (DORC, Holland). The length (without its head) is 4 mm, the internal diameter is 0.65 mm, and the external diameter is 0.75 mm. The external opening is funnel shaped.
jkos-50-1066f1.tif
Figure 2.
Intraoperative photograph of the procedure searching sclerotomy-related retinal breaks by 360° scleral depression.
jkos-50-1066f2.tif
Table 1.
Patient demographics, 20- vs 23-gauge vitrectomy systems
20-Gauge 23-Gauge p-value
Number of eyes 62 63
Sex (male/female) 30/32 39/24 0.152*
Age (yr)(mean± SD) 52.9±10.74 57.32±10.27 0.052
Laterality (OD/OS) 29/33 29/34 1.000*
Lens status (phakic/pseudophakic) 46/16 47/16 1.000*
Preop visual acuity (logMAR)(mean± SD) 1.29±0.52 0.74±0.45 <0.001

* Fisher's exact test

Independent t-test.

Table 2.
Intraop procedures, 20- vs 23-gauge vitrectomy systems
20-Gauge (n=62) 23-Gauge (n=63)
Procedures
Cataract extraction 30 (48.4%) 45 (71.4%)
Membrane peeling 61 (98.4%) 57 (90.5%)
Laser 54 (87.1%) 62 (98.4%)
Cryotherapy 62 (100%) 63 (100%)
Tamponade
Silicone oil 16 (25.8%) 9 (14.3%)
Gas (C3F8) 2 (3.2%) 4 (6.3%)
Air 0 (0%) 46 (73.0%)
BSS 44 (71.0%) 4 (6.3%)
Table 3.
Indications for surgery
20-Gauge(%) 23-Gauge(%)
Vitreous hemorrhage* 36 (58.0) 37 (58.7)
Traction retinal detachment 20 (32.3) 18 (28.6)
Diabetic macular edema 1 (1.6) 4 (6.3)
Epiretinal membrane 5 (8.1) 4 (6.3)
Total 62 63

p=0.568 by chi-square test.

* non-clearing vitreous hemorrhage without traction retinal detachment.

Table 4.
Details for patients discovered to have sclerotomy-related retinal breaks
Gauge Sex/Age Laterality Indication Intraop Procedure Tamponade Tear location Retinal detachment
20 F/70 OD VH* PPV/cat§/MPП/l#/c** BSS†† Superotemporal No
20 M/58 OS VH PPV/cat/MP/l/c Gas (C3F8) Superonasal Yes (4 months)
20 F/37 OS VH PPV/cat/MP/l/c BSS Superonasal No
23 M/49 OS TRD PPV/cat/MP/l/c Air Superonasal Yes (3 months)
23 F/53 OS TRD PPV/cat/MP/c Gas (C3F8) Superonasal No

* VH=vitreous hemorrhage

TRD=traction retinal detachment

PPV=pars plana vitrectomy

§ cat=cataract extraction

П MP= membrane peeling

# l=endolaser

** c=cryotherapy

†† BSS=Balanced salt solution.

Table 5.
Other intraoperative and postoperative complications
20-Gauge (n=62) 23-Gauge (n=63)
Intraoperative complications
Iatrogenic retinal tear 5 (8.1%) 4 (6.3%)
Postoperative complications
Recurrent vitreous hemorrhage 5 (8.1%) 3 (4.5%)
Neovascular glaucoma 3 (4.8%) 1 (1.6%)
Proliferative vitreoretinopathy 2 (3.2%) 0 (0%)
Macular edema 7 (11.3%) 9 (14.2%)
Persistent subretinal fluid (reoperation) 0 (0%) 1 (1.6%)
TOOLS
Similar articles