Surgical Outcomes of Transconjunctival 25-Gauge Plus Pars Plana Vitrectomy for Rhegmatogenous Retinal Detachment

Yeon Ho Lee; Ju Hong Park; Min Sagong; Woo Hyok Chang

doi:10.7469/JKOS.2015.56.03.351

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Lee, Park, Sagong, and Chang: Surgical Outcomes of Transconjunctival 25-Gauge Plus Pars Plana Vitrectomy for Rhegmatogenous Retinal Detachment

Original Article

J Korean Ophthalmol Soc 2015;56(3):351-356.

Published online: 7 September 2015

DOI: https://doi.org/10.7469/JKOS.2015.56.03.351

Surgical Outcomes of Transconjunctival 25-Gauge Plus Pars Plana Vitrectomy for Rhegmatogenous Retinal Detachment

Yeon Ho Lee, MD, Ju Hong Park, MD, Min Sagong, MD, PhD, Woo Hyok Chang, MD, PhD

Department of Ophthalmology, Yeungnam University College of Medicine, Daegu, Korea

￭ Address reprint requests to Woo Hyok Chang, MD, PhD Department of Ophthalmology, Yeungnam University Medical Center, #170 Hyeonchung-ro, Nam-gu, Daegu 705-802, Korea Tel: 82-53-620-3443, Fax: 82-53-626-5936 E-mail: changwh@ynu.ac.kr

Received 31 May 201413 September 2014 Accepted 1 March 2015

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.

초록

Purpose:

To evaluate anatomical and visual results of transconjunctival 25‐ gauge plus pars plana vitrectomy (PPV) in the management of primary rhegmatogenous retinal detachment (RRD).

Methods:

A retrospective analysis of 46 eyes of 46 patients who underwent transconjunctival 25-gauge plus PPV for primary RRD repair between January 2013 and May 2013 with a minimum of 3-month follow-up was performed. Data collected for the study included patient demographics, lens status, preoperative visual acuity, macular status, and location and number of primary breaks. Main outcome measures were anatomical reattachment rate, postoperative visual acuity, operation time, and postoperative complications.

Results:

The study included 30 men and 16 women. The mean age of the patients was 54.3 years. The locations of retinal breaks were 24 (52.2%) eyes in the superior half, 15 (32.6%) eyes in the inferior half, and 7 (15.2%) eyes on both sides. The macula-on RRD was present preoperatively in 21 (45.7%) of 46 eyes. Of the 33 (71.7%) phakic eyes, 18 (39.1%) underwent combined phacoemulsification, intraocular lens implantation, and PPV. Two different tamponades, C₃ F₈ gas and silicone oil were used in this study. C₃ F₈ gas was injected in the 33 (71.7%) eyes, and the remaining eyes were filled with silicone oil (1,300 centistokes for 11 eyes, 5,700 centistokes for 2 eyes). Mean operation time was 48.8 ± 13.2 minutes. Retinal reattachment was achieved in 45 (97.8%) of 46 eyes at 3 months. Mean best-corrected visual acuity improved from 1.33 ± 1.20 log MAR preoperatively to 0.68 ±0.94 log MAR postoperatively ( p < 0.001). Postoperative complications included transient intraocular pressure elevation in 6 (13.1%) eyes and posterior capsular opacity in 3 (6.5%) eyes.

Conclusions:

It seems that transconjunctival 25-gauge plus PPV can be a safe and effective option for surgical management of RRD.

Keywords: Rhegmatogenous retinal detachment, Transconjunctival 25-gauge plus vitrectomy

References

1. Haimann MH, Burton TC, Brown CK. Epidemiology of retinal detachment. Arch Ophthalmol. 1982; 100:289–92.

2. Gonin J. The treatment of detached retina by searing the retinal tears. Arch Ophthalmol. 1930; 4:621–5.

3. 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.

4. Fujii GY, De Juan E Jr, Humayun MS, et al. Initial experience using the transconjunctival sutureless vitrectomy system for vitreoretinal surgery. Ophthalmology. 2002; 109:1814–20.

5. Fujii GY, De Juan E Jr, Humayun MS, et al. A new 25-gauge instru-ment system for transconjunctival sutureless vitrectomy surgery. Ophthalmology. 2002; 109:1807–12. discussion 1813.

6. de Juan E Jr, Hickingbotham D. Refinements in microinstrumentation for vitreous surgery. Am J Ophthalmol. 1990; 109:218–20.

7. Lakhanpal RR, Humayun MS, de Juan E Jr, et al. Outcomes of 140 consecutive cases of 25-gauge transconjunctival surgery for posterior segment disease. Ophthalmology. 2005; 112:817–24.

8. Ibarra MS, Hermel M, Prenner JL, Hassan TS. Longer-term outcomes of transconjunctival sutureless 25-gauge vitrectomy. Am J Ophthalmol. 2005; 139:831–6.

9. Eckardt C. Transconjunctival sutureless 23-gauge vitrectomy. Retina. 2005; 25:208–11.

10. 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.

11. Kim OJ, Lee TG, Na SJ. Primary 23 gauge transconjunctival sutureless vitrectomy with air tamponade for simple rhegmatogenous retinal detachment. J Korean Ophthalmol Soc. 2011; 52:190–6.

12. Rizzo S, Genovesi-Ebert F, Belting C. Comparative study between a standard 25-gauge vitrectomy system and a new ultrahigh-speed 25-gauge system with duty cycle control in the treatment of various vitreoretinal diseases. Retina. 2011; 31:2007–13.

13. Teixeira A, Chong L, Matsuoka N, et al. Novel method to quantify traction in a vitrectomy procedure. Br J Ophthalmol. 2010; 94:1226–9.

14. Teixeira A, Chong LP, Matsuoka N, et al. Vitreoretinal traction created by conventional cutters during vitrectomy. Ophthalmology. 2010; 117:1387–92.e2.

15. Charles S. An engineering approach to vitreoretinal surgery. Retina. 2004; 24:435–44.

16. Von Fricken MA, Kunjukunju N, Weber C, Ko G. 25-Gauge sutureless vitrectomy versus 20-gauge vitrectomy for the repair of primary rhegmatogenous retinal detachment. Retina. 2009; 29:444–50.

17. Tsang CW, Cheung BT, Lam RF, et al. Primary 23-gauge transconjunctival sutureless vitrectomy for rhegmatogenous retinal detachment. Retina. 2008; 28:1075–81.

18. Yanyali A, Celik G, Dincyildiz A, et al. Primary 23-gauge vitreoretinal surgery for rhegmatogenous retinal detachment. Int J Ophthalmol. 2012; 5:226–30.

19. Mura M, Tan SH, De Smet MD. Use of 25-gauge vitrectomy in the management of primary rhegmatogenous retinal detachment. Retina. 2009; 29:1299–304.

20. Dell’Omo R, Barca F, Tan HS, et al. Pars plana vitrectomy for the repair of primary, inferior rhegmatogenous retinal detachment associated to inferior breaks. A comparison of a 25-gauge versus a 20-gauge system. Graefes Arch Clin Exp Ophthalmol. 2013; 251:485–90.

21. Lai MM, Ruby AJ, Sarrafizadeh R, et al. Repair of primary rhegmatogenous retinal detachment using 25-gauge transconjunctival sutureless vitrectomy. Retina. 2008; 28:729–34.

22. Shin MK, Lee JE, Oum BS. Comparison between 20-gauge and 23-gauge vitrectomy system in primary vitrectomy for rhegmatogenous retinal detachment. J Korean Ophthalmol Soc. 2009; 50:405–11.

23. Gu BY, Sagong M, Chang WH. Phacovitrectomy versus vitrectomy only for primary rhegmatogenous retinal detachment repair. J Korean Ophthalmol Soc. 2011; 52:537–43.

24. Lee GW, Na SJ, Lee YH, et al. Complication incidence of day sur-geries with 23 gauge vitrectomy. J Korean Ophthalmol Soc. 2012; 53:1823–7.

25. Byon IS, Pak KY, Lee SM, et al. Lens-save versus phacoemulsification with intraocular lens implantation in primary vitrectomy for phakic rhegmatogenous retinal detachment. J Korean Ophthalmol Soc. 2013; 54:449–55.

26. Acar N, Kapran Z, Unver YB, et al. Early postoperative hypotony after 25-gauge sutureless vitrectomy with straight incisions. Retina. 2008; 28:545–52.

Table 1.

Preoperative characteristics of patients

Characteristics
Age (years)
Mean ± SD	54.3 ± 11.9
Median	53
Sex (n, %)
Male	30 (65.2)
Female	16 (34.8)
Operated (no. of eyes, %)
Right	20 (43.5)
Left	26 (56.5)
Lens status (n, %)
Phakic	33 (71.7)
Pseudophakic	12 (26.1)
Aphakic	1 (2.2)
Preopoerative visual acuity (mean ±	SD, log MAR) 1.33 ± 1.20

SD = standard deviation.

Table 2.

Preoperative characteristics of retinal break and rhegmatogenous retinal detachment

Characteristics	Patients (%)
Location of breaks
Superior quadrant	24 (52.2)
Inferior quadrant	15 (32.6)
Both superior and inferior quadrants	7 (15.2)
Number of retinal breaks
1	22 (47.8)
2	15 (32.6)
>2	9 (19.6)
Macula detachment
Macula on	21 (45.7)
Macula off	25 (54.3)
Quadrant of retinal detachment
1 quadrant	23 (50.0)
2 quadrant	14 (30.4)
3 quadrant	4 (8.7)
4 quadrant	5 (10.9)

Table 3.

Postoperative results

Characteristics
Primary reattachment rate (n, %)		45/46 (97.8)
Combined cataract operation (n, %)		28/46 (53.57)
Gas tamponade (n, %)
C₃ F₈		33 (71.7)
Silicone oil
1300 centistokes		11 (84.6)
5700 centistokes		2 (15.4)
Operation time (min)
Total		48.8 ± 13.2
With cataract operation		53.6 ± 12.7
Without cataract operation		41.4 ± 10.7
Visual acuity (log MAR)	Preoperative VA	Postoperative VA	p-value
Total	1.33 ± 1.20	0.68 ± 0.94	<0.001
Macular on RD	0.71 ± 1.07	0.33 ± 0.71	0.034
Macular off RD	1.86 ± 1.06	0.97 ± 1.02	0.002

Values are presented as mean ± SD unless otherwise indicated.

VA = visual acuity; RD = retinal detachment.

Table 4.

Postoperative complications of primary 25 G plus vitrectomy for rhegmatogenous retinal detachment

Complications	N (%)
Increased intraocular pressure^*	6 (13.1)
Posterior capsular opacity	3 (6.5)
Transient hypotony	3 (6.5)
Intraocular lens capture	1 (2.2)
Iatrogenic tear	0 (0)

^* Controlled by topical medication in all cases.

Table 5.

Result of individual trials in 23-gauge and 25-gauge vitrectomy group

Vitrectomy system	Author	Year	Patient/eyes (n)	Primary reattached rate (%)
23-gauge	Tsang	2008	24/24	91.7
	Yanyali	2012	49/49	95.9
25-gauge	Von Fricken	2009	64/64	90.6
	Mura	2009	131/131	92.4
	Dell’Omo	2013	41/41	92.7

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