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

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

J Korean Ophthalmol Soc 2009;50(3):405-411.

Published online: 31 August 2009

DOI: https://doi.org/10.3341/jkos.2009.50.3.405

Comparison Between 20-Gauge and 23-Gauge Vitrectomy System in Primary Vitrectomy for Rhegmatogenous Retinal Detachment

Min Kyu Shin, MD1, Ji Eun Lee, MD, PhD1, 2, Boo Sup Oum, MD, PhD1, 2

1Department of Ophthalmology, School of Medicine, Pusan National University, Pusan, Korea

2Medical Research Institute, Pusan National University, Pusan, Korea

Address reprint requests to Ji Eun Lee, MD, PhD, Department of Ophthalmology, Pusan National University Hospital #1-10 Ami-dong, Seo-gu, Pusan 602-739, Korea Tel: 82-51-240-7957, Fax: 82-51-242-7341, E-mail: jlee@pusan.ac.kr

Received 13 June 2008       Accepted 30 September 2008

Copyright © 2009 Korean Ophthalmological Society

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

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.

Keywords: Operation time, Rhegmatogenous retinal detachment, Transconjunctival sutureless vitrectomy

References

1. Gonin J. Treatment of detached retina by searing the retinal tears. Arch Ophthalmol. 1930; 4:621–5.
2. Custodis E. Importance of the vitreous body in retina surgery with special emphasis on reoperations. 1st ed.St. Louis: C.V. Mosby;1960. p. 75–8.
3. Machemer R, Buettner H, Norton EW, Parel JM. Vitrectomy. A pars plana approach. Trans Am Acad Ophthalmol Otolaryngol. 1971; 75:813–6.
4. Han DP, Mohsin NC, Guse CE, et al. Comparison of pnuematic retinopexy and scleral buckling in management of primary rhegmatogenous retinal detachment. Am J Ophthalmol. 1998; 126:658–68.
5. Park JL, Kim SD, Yun IH. A clinical study of the rhegmatogenous retinal detachment. J Korean Ophthalmol Soc. 2003; 43:1015–24.
6. Kang SW, Kim SW. The Korean Retina Society, Preference for treatment modalities of simple rhegmatogeonous retinal detachment in Korea. J Korean Ophthalmol Soc. 2002; 43:1179–85.
7. Fujii GY, De Juan E Jr, Humayun MS, et al. A new 25-gauge instrument system for transconjunctival sutureless vitrectomy surgery. Ophthalmology. 2002; 109:1807–13.
8. Eckardt C. Transconjunctival sutureless 23-gauge vitrectomy. Retina. 2005; 25:208–11.
crossref
9. Fine HF, Iranmanesh R, Iturralde D, Spaide RF. Outcomes of 77 Consecutive Cases of 23-Gauge Transconjunctival Vitrectomy Surgery for Posterior Segment Disease. Ophthalmology. 2007; 114:1197–200.
crossref
10. Michels RG, Wilkinson CP, Rice TA. Retinal detachment. 1st ed.St. Louis: Mosby;1990. p. 917–58.
11. American Academy of Ophthalmology. Information statement: the repair of retinal detachment. Ophthalmology. 1990; 97:1562.
12. Escoffery RF, Olk RJ, Grand MG, Boniuk I. Vitrectomy without scleral buckling for primary rhegmatogenous retinal detachment. Am J Ophthalmol. 1985; 99:275–81.
crossref
13. Hakin KN, Lavin MJ, Leaver PK. Primary vitrectomy for rhe-gmatogenous retinal detachment. Graefes Arch Clin Exp Ophthalmol. 1993; 231:344–6.
crossref
14. Oshima Y, Yamanashi S, Sawa M, et al. Two-year follow-up study comparing primary vitrectomy with scleral buckling for macular-off rhegmatogenous retinal detachment. Jpn J Ophthalmol. 2000; 44:538–49.
15. Sharma YR, Karunanithi S, Azad RV, et al. Functional and anatomic outcome of scleral buckling versus primary vitrectomy in pseudophakic retinal detachment. Acta Ophthalmol Scand. 2005; 83:293–97.
crossref
16. Woon WH, Burdon MA, Green WT, Chignell AH. Comparison of pars plana vitrectomy and scleral buckling for uncomplicated rhegmatogenous retinal detachment. Curr Opin Ophthalmol. 1995; 6:76–9.
17. Choi HY, Oum BS. Primary vitrectomy in rhegmatogenous retinal detachment. J Korean Ophthalmol Soc. 1998; 39:121–30.
18. Heimann H, Zou X, Jandeck C, et al. Primary vitrectomy for rhegmatogenous retinal detachment: an analysis of 512 cases. Graefes Arch Clin Exp Ophthalmol. 2006; 244:69–78.
crossref
19. Newman DK, Burton RL. Primary vitrectomy for pseudophakic and aphakic retinal detachments. Eye. 1999; 13:635–9.
crossref
20. Bartz-Schmidt KU, Kirchhof B, Heimann K. Primary vitrectomy for pseudophakic retinal detachment. Br J Ophthalmol. 1996; 80:346–9.
crossref
21. Amato JE, Akdauman L. Incidence of complications in 25-gauge transconjunctival sutureless vitrectomy based on the surgical indications. Ophthalmic Surg Lasers Imaging. 2007; 38:100–2.
crossref
22. Gupta OP, Weichel ED, Regillo CD, et al. Postoperative complications associated with 25-gauge pars plana vitrectomy. Ophthalmic Surg Lasers Imaging. 2007; 38:270–5.
crossref
23. Charles S. Debating the pros and cons of 23-g vs. 25-g vitrectomy: the pros of 25-g vitrectomy. Retin Physician. 2006; 3:24–5.

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.

TOOLS
Similar articles