Early surgical results of a 23-gauge trocar combined with a one-directional valve system in primary and secondary pars plana vitrectomy
To elucidate the early surgical advantages of a 23-gauge trocar combined with a one-directional valve system in transconjunctival pars plana vitrectomies. Materials and methods: Early surgical results of 432 eyes of 432 patients (190 female and 242 male) who underwent 23-gauge (23G) transconjunctival sutureless vitrectomies (TSV) were evaluated. Sixty-three patients out of 432 underwent a second operation, 29 of them underwent silicone oil extraction, and 34 had phacoemulsification surgery with the help of vitreous infusion. If any sign of leakage was observed after the withdrawal of the cannulae, a suture was applied at the conjunctiva-scleral opening site. Results: A total of 21 (4.8%) patients in the first operation and 7 (11.1%) cases in the second operation needed suture in at least 1 sclerotomy site. No one had intraoperative hypotony. On postoperative day 1, 37 initial surgery patients and 3 second TSV patients had hypotony; all of them resolved spontaneously 1 week after surgery. No one developed choroidal effusions or detachment. Intraocular pressure spikes more than 22 mmHg in day 1 occurred in 18 eyes after initial TSV; 6 of them had gas and 4 eyes had silicone tamponade. Conclusion: 23G TSV is an effective and safe procedure for both first vitreoretinal surgery and second intraocular surgeries in eyes that had TSV previously.
Early surgical results of a 23-gauge trocar combined with a one-directional valve system in primary and secondary pars plana vitrectomy
To elucidate the early surgical advantages of a 23-gauge trocar combined with a one-directional valve system in transconjunctival pars plana vitrectomies. Materials and methods: Early surgical results of 432 eyes of 432 patients (190 female and 242 male) who underwent 23-gauge (23G) transconjunctival sutureless vitrectomies (TSV) were evaluated. Sixty-three patients out of 432 underwent a second operation, 29 of them underwent silicone oil extraction, and 34 had phacoemulsification surgery with the help of vitreous infusion. If any sign of leakage was observed after the withdrawal of the cannulae, a suture was applied at the conjunctiva-scleral opening site. Results: A total of 21 (4.8%) patients in the first operation and 7 (11.1%) cases in the second operation needed suture in at least 1 sclerotomy site. No one had intraoperative hypotony. On postoperative day 1, 37 initial surgery patients and 3 second TSV patients had hypotony; all of them resolved spontaneously 1 week after surgery. No one developed choroidal effusions or detachment. Intraocular pressure spikes more than 22 mmHg in day 1 occurred in 18 eyes after initial TSV; 6 of them had gas and 4 eyes had silicone tamponade. Conclusion: 23G TSV is an effective and safe procedure for both first vitreoretinal surgery and second intraocular surgeries in eyes that had TSV previously.
___
- 1. Kim MJ, Park KH, Hwang JM, Yu HG, Yu YS, Chung H. The safety and efficacy of transconjunctival sutureless 23-gauge vitrectomy. Korean J Ophthalmol 2007; 21: 201–207.
- 2. Eckardt C. Transconjunctival sutureless 23-gauge vitrectomy. Retina 2005; 25: 208–211.
- 3. Chieh JJ, Rogers AH, Wiegand TW, Baumal CR, Reichel E, Duker JS. Short-term safety of 23-gauge single-step transconjunctival vitrectomy surgery. Retina 2009; 29: 1486– 1490.
- 4. Singh CN, Iezzi R, Mahmoud TH. Intraocular pressure instability after 23- gauge vitrectomy. Retina 2010; 30: 629–634.
- 5. Gupta OP, Ho AC, Kaiser PK, Regillo CD, Chen S, Dyer DS, Dugel PU, Gupta S, Pollack JS. Short-term outcomes of 23-gauge pars plana vitrectomy. Am J Ophthalmol 2008; 146: 789–790.
- 6. Woo SJ, Park KH, Hwang JM, Kim JH, Yu YS, Chung H. Risk factors associated with sclerotomy leakage and postoperative hypotony after 23-gauge transconjunctival sutureless vitrectomy. Retina 2009; 29: 456–463.
- 7. Parolini B, Prigione G, Romanelli F, Cereda MG, Sartore M, Pertile G. Postoperative complications and intraocular pressure in 943 consecutive cases of 23-gauge transconjunctival pars plana vitrectomy with 1-year follow-up. Retina 2010; 30: 107– 111.
- 8. Erakgun T, Egrilmez S. Surgical outcomes of transconjunctival sutureless 23- gauge vitrectomy with silicone oil injection. Indian J Ophthalmol 2009; 57: 105–109.
- 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: 1197–1200.
- 10. Schweitzer C, Delyfer MN, Colin J, Korobelnik JF. 23-gauge transconjunctival sutureless pars plana vitrectomy: results of a prospective study. Eye 2009; 23: 2206–2214.
- 11. de Preobrajensky N, Mrejen S, Adam R, Ayello-Scheer S, Gendron G, Rodallec T, Sahel JA, Barale PO. 23-Gauge transconjunctival sutureless vitrectomy: a retrospective study of 164 consecutive cases. J Fr Ophthalmol 2010; 33: 99–104 (article in French with an abstract in English).
- 12. Misra A, Ho-Yen G, Burton RL. 23-Gauge sutureless vitrectomy and 20-gauge vitrectomy: a case series comparison. Eye 2009; 23: 1187–1191.