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27-gauge vitrectomy for posterior segment eye disease: experience at a tertiary care center in Kashmir, India
- Department of Ophthalmology, Government Medical College, Srinagar, Jammu and Kashmir, India
open access
Abstract
Background: The aim of this work was to study the clinical outcomes, operative time, and complications of 27-gauge (27G) microincision vitrectomy surgery in posterior segment eye disease (PSED).
Material and methods: This prospective observational study was conducted at a tertiary care hospital in Kashmir, India. 27G transconjunctival sutureless vitrectomy was performed on 101 eyes of 101 patients with PSED.
Results: Of 101 patients, pars plana vitrectomy was indicated for retinal detachment (RD) (n = 36, 35.7%), vitreous hemorrhage (n = 35, 34.7%), epiretinal membrane (ERM)/vitreomacular traction (VMT) (n = 16, 15.9%), macular hole (n = 7, 6.9%), endophthalmitis (n = 4, 3.9%) and intraocular lens drop (n = 3, 2.9%). We observed significant improvement in mean logMAR visual acuity for all indications (p < 0.05 each). Tamponade agents used were fluid (n = 51, 50.5%), silicone oil (n = 30, 29.7%), SF6 gas (n = 15, 14.85%), C3F8 gas (n = 3, 2.97%) and air (n = 2, 1.98%). The intraocular pressure (IOP) increased significantly in cases where silicone oil and SF6 gas were used as tamponade agents (p < 0.05 each). Mean IOP initially increased on the first postoperative day followed by a gradual decline. Overall, the mean operating time was 37.08 minutes and duration of vitreous removal 22.41 minutes. Intraoperative complications included suprachoroidal hemorrhage (n = 1, 0.99%) and inadvertent retinal breaks (n = 1, 0.99%). Postoperative complications included transient hypotony (n = 2, 1.98%), transient ocular hypertension (n = 12, 11.88%), postoperative vitreous hemorrhage (n = 3, 2.97%), recurrent RD (n = 1, 0.99%) and emulsification of silicone oil (n = 3, 2.97%).
Conclusions: The 27G system was safe and effective for treating a broad spectrum of PSED. Minimal complications
and good visual outcomes warrant a wider adoption of this technique.
Abstract
Background: The aim of this work was to study the clinical outcomes, operative time, and complications of 27-gauge (27G) microincision vitrectomy surgery in posterior segment eye disease (PSED).
Material and methods: This prospective observational study was conducted at a tertiary care hospital in Kashmir, India. 27G transconjunctival sutureless vitrectomy was performed on 101 eyes of 101 patients with PSED.
Results: Of 101 patients, pars plana vitrectomy was indicated for retinal detachment (RD) (n = 36, 35.7%), vitreous hemorrhage (n = 35, 34.7%), epiretinal membrane (ERM)/vitreomacular traction (VMT) (n = 16, 15.9%), macular hole (n = 7, 6.9%), endophthalmitis (n = 4, 3.9%) and intraocular lens drop (n = 3, 2.9%). We observed significant improvement in mean logMAR visual acuity for all indications (p < 0.05 each). Tamponade agents used were fluid (n = 51, 50.5%), silicone oil (n = 30, 29.7%), SF6 gas (n = 15, 14.85%), C3F8 gas (n = 3, 2.97%) and air (n = 2, 1.98%). The intraocular pressure (IOP) increased significantly in cases where silicone oil and SF6 gas were used as tamponade agents (p < 0.05 each). Mean IOP initially increased on the first postoperative day followed by a gradual decline. Overall, the mean operating time was 37.08 minutes and duration of vitreous removal 22.41 minutes. Intraoperative complications included suprachoroidal hemorrhage (n = 1, 0.99%) and inadvertent retinal breaks (n = 1, 0.99%). Postoperative complications included transient hypotony (n = 2, 1.98%), transient ocular hypertension (n = 12, 11.88%), postoperative vitreous hemorrhage (n = 3, 2.97%), recurrent RD (n = 1, 0.99%) and emulsification of silicone oil (n = 3, 2.97%).
Conclusions: The 27G system was safe and effective for treating a broad spectrum of PSED. Minimal complications
and good visual outcomes warrant a wider adoption of this technique.
Keywords
pars plana vitrectomy; diabetic retinopathy; epiretinal membrane; macular hole; retinal detachment
Title
27-gauge vitrectomy for posterior segment eye disease: experience at a tertiary care center in Kashmir, India
Journal
Issue
Vol 7 (2022): Continuous Publishing
Article type
Original paper
Pages
26-34
Published online
2022-03-17
Page views
4941
Article views/downloads
712
DOI
Bibliographic record
Ophthalmol J 2022;7:26-34.
Keywords
pars plana vitrectomy
diabetic retinopathy
epiretinal membrane
macular hole
retinal detachment
Authors
Madhurima Kaushik
Tariq Syed Qureshi
Faisal Qayoom Shah
- Juan Ede, Hickingbotham D. Refinements in Microinstrumentation for Vitreous Surgery. Am J Ophthalmol. 1990; 109(2): 218–220.
- Eckardt C. Transconjunctival sutureless 23-gauge vitrectomy. Retina. 2005; 25(2): 208–211.
- Chen E. 25-Gauge transconjunctival sutureless vitrectomy. Curr Opin Ophthalmol. 2007; 18(3): 188–193.
- Spirn MJ. Comparison of 25, 23 and 20-gauge vitrectomy. Curr Opin Ophthalmol. 2009; 20(3): 195–199.
- Okamoto F, Okamoto C, Sakata N, et al. Changes in corneal topography after 25-gauge transconjunctival sutureless vitrectomy versus after 20-gauge standard vitrectomy. Ophthalmology. 2007; 114(12): 2138–2141.
- Oshima Y, Wakabayashi T, Sato T, et al. A 27-gauge instrument system for transconjunctival sutureless microincision vitrectomy surgery. Ophthalmology. 2010; 117(1): 93–102.e2.
- Mohamed S, Claes C, Tsang CW. Review of Small Gauge Vitrectomy: Progress and Innovations. J Ophthalmol. 2017; 2017: 6285869.
- Shah CP, Ho AC, Regillo CD, et al. Short-term outcomes of 25-gauge vitrectomy with silicone oil for repair of complicated retinal detachment. Retina. 2008; 28(5): 723–728.
- Patelli F, Radice P, Zumbo G, et al. 25-gauge macular surgery: results and complications. Retina. 2007; 27(6): 750–754.
- Yang SJ, Yoon SY, Kim Jg, et al. Transconjunctival sutureless vitrectomy for the treatment of vitreoretinal complications in patients with diabetes mellitus. Ophthalmic Surg Lasers Imaging. 2009; 40(5): 461–466.
- Lange C, Feltgen N, Junker B, et al. Resolving the clinical acuity categories "hand motion" and "counting fingers" using the Freiburg Visual Acuity Test (FrACT). Graefes Arch Clin Exp Ophthalmol. 2009; 247(1): 137–142.
- Kozak I, Luttrull JK. Modern retinal laser therapy. Saudi J Ophthalmol. 2015; 29(2): 137–146.
- Rodrigues EB, Meyer CH, Kroll P. Chromovitrectomy: a new field in vitreoretinal surgery. Graefes Arch Clin Exp Ophthalmol. 2005; 243(4): 291–293.
- Vaziri K, Schwartz SG, Kishor KS, et al. Tamponade in the surgical management of retinal detachment. Clin Ophthalmol. 2016; 10: 471–476.
- Li J, Liu SM, Dong WT, et al. Outcomes of transconjunctival sutureless 27-gauge vitrectomy for vitreoretinal diseases. Int J Ophthalmol. 2018; 11(3): 408–415.
- Rizzo S, Barca F, Caporossi T, et al. Twenty-seven-gauge vitrectomy for various vitreoretinal diseases. Retina. 2015; 35(6): 1273–1278.
- Khan MA, Shahlaee A, Toussaint B, et al. Outcomes of 27 Gauge Microincision Vitrectomy Surgery for Posterior Segment Disease. Am J Ophthalmol. 2016; 161: 36–43.e1.
- Mitsui K, Kogo J, Takeda H, et al. Comparative study of 27-gauge vs 25-gauge vitrectomy for epiretinal membrane. Eye (Lond). 2016; 30(4): 538–544.
- Yoneda K, Morikawa K, Oshima Y, et al. Japan Microincision Vitrectomy Surgery Study Group. SURGICAL OUTCOMES OF 27-GAUGE VITRECTOMY FOR A CONSECUTIVE SERIES OF 163 EYES WITH VARIOUS VITREOUS DISEASES. Retina. 2017; 37(11): 2130–2137.
- Rizzo S, Polizzi S, Barca F, et al. Comparative Study of 27-Gauge versus 25-Gauge Vitrectomy for the Treatment of Primary Rhegmatogenous Retinal Detachment. J Ophthalmol. 2017; 2017: 6384985.
- Khan MA, Kuley A, Riemann CD, et al. Long-Term Visual Outcomes and Safety Profile of 27-Gauge Pars Plana Vitrectomy for Posterior Segment Disease. Ophthalmology. 2018; 125(3): 423–431.
- Naruse Z, Shimada H, Mori R. Surgical outcomes of 27-gauge and 25-gauge vitrectomy day surgery for proliferative diabetic retinopathy. Int Ophthalmol. 2019; 39(9): 1973–1980.
- Sborgia G, Niro A, Sborgia L, et al. One-year outcomes of 27-gauge versus 25-gauge pars plana vitrectomy for uncomplicated rhegmatogenous retinal detachment repair. Int J Retina Vitreous. 2019; 5: 13.
- Fine HF, Iranmanesh R, Iturralde D, et al. Outcomes of 77 consecutive cases of 23-gauge transconjunctival vitrectomy surgery for posterior segment disease. Ophthalmology. 2007; 114(6): 1197–1200.
- Lakhanpal RR, Humayun MS, de Juan E, et al. Outcomes of 140 consecutive cases of 25-gauge transconjunctival surgery for posterior segment disease. Ophthalmology. 2005; 112(5): 817–824.
- Chen PL, Chen YT, Chen SN. Comparison of 27-gauge and 25-gauge vitrectomy in the management of tractional retinal detachment secondary to proliferative diabetic retinopathy. PLoS One. 2021; 16(3): e0249139.
- Sborgia G, Niro A, Sborgia L, et al. One-year outcomes of 27-gauge versus 25-gauge pars plana vitrectomy for uncomplicated rhegmatogenous retinal detachment repair. Int J Retina Vitreous. 2019; 5: 13.
- Lubiński W, Gosławski W, Podborączyńska-Jodko K, et al. Comparison of 27-gauge versus 25-gauge vitrectomy results in patients with epiretinal membrane: 6-month follow-up. Int Ophthalmol. 2020; 40(4): 867–875.
- Romano MR, Cennamo G, Ferrara M, et al. Twenty-seven gauge versus twenty-five gauge vitrectomy for primary rhegmatogenous retinal detachment. Retina. 2017; 37(4): 637–642.
- Ibarra MS, Hermel M, Prenner JL, et al. Longer-term outcomes of transconjunctival sutureless 25-gauge vitrectomy. Am J Ophthalmol. 2005; 139(5): 831–836.
- Gupta OPI, Weichel ED, Regillo CD, et al. Postoperative complications associated with 25-gauge pars plana vitrectomy. Ophthalmic Surg Lasers Imaging. 2007; 38(4): 270–275.
- Gupta OP, Ho AC, Kaiser PK, et al. Short-term outcomes of 23-gauge pars plana vitrectomy. Am J Ophthalmol. 2008; 146(2): 193–197.
- Dugel PU, Zhou J, Abulon DJ, et al. Tissue attraction associated with 20-gauge, 23-gauge, and enhanced 25-gauge dual-pneumatic vitrectomy probes. Retina. 2012; 32(9): 1761–1766.
- Dugel PU, Abulon DJK, Dimalanta R. Comparison of attraction capabilities associated with high-speed, dual-pneumatic vitrectomy probes. Retina. 2015; 35(5): 915–920.
- Anastasilakis K, Mourgela A, Kaniouras D, et al. Tips, Tricks, and Advantages of 27-G Vitrectomy. Ophthalmologica. 2018; 239(2-3): 176–177.