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Purpose: To compare the safety, efficacy and complications (intra and post - operative) of 25 and 23 – gauge transconjunctival suture less vitrectomy.
Material and Methods: It was a single centre, prospective, interventional case series. Fifty eight eyes underwent pars plana vitrectomy using one of the two surgical procedures in Ophthalmology department of Sir Ganga Ram Hospital, Lahore from July 2010 to January 2012. 24 eyes were operated using 25 – gauge and 34 eyes with 23-gauge surgical instruments and technique. In 25 – gauge series, majority of the patients (22 cases, 91.7%) had vitreous hemorrhage as complication of proliferative diabetic retinopathy and venous occlusion complicating into vitreous hemorrhage in remaining 2 cases (8.3%). Vitreous hemorrhage with epiretinal membranes overlying macula (6 cases, 25%) and vitreous hemorrhage alone (18 cases, 75%). 23 gauge series included a greater variety of vitreo-retinal pathologies like vitreous hemorrhage (22 cases) due to proliferative diabetic retinopathy, with epiretinal membranes (10 cases, 29.4%) or without (12 cases, 35.3%) epiretinal membranes, rhegmatogenous retinal detachment (12 cases, 35.5%), out of which superior RD was seen in 10 cases and total RD in 2 cases. In 25 – gauge series, internal tamponade was not required while in 23- gauge series, silicone oil (1000cst) for internal tamponade was used in 18 eyes (52.9%).
Results: In 25-gauge series, most of the procedure was possible. However, the 25 – gauge instruments are quite delicate, narrow gauge and fragile. Bending of the fiber optic light frequently occurred during procedure. The thin epiretinal membranes were easily peeled off from macular area but the stiffer membranes could not be lifted or cut easily with delicate 25 – gauge curved scissors. Instead, vitreous cutter was used to lift and peel the membranes. The fragility of instruments hindered ocular rotation making peripheral vitreous shaving difficult and so required indentation. In 23 – gauge series, the instruments are relatively stiffer making it possible to complete the procedure with ease with including silicone oil fill. Most common complication seen in 25 – gauge series was transient vitreous hemorrhage (6 eyes, 25%) while in 23-gauge series, transient low IOP (14 eyes, 41.2%), transient recurrent vitreous hemorrhage (4 eyes, 11.8%) and scanty leakage of silicone oil (6 eyes, 11.7%) was seen. No wound suturing was required in either series. Visual acuity improved in both groups in postoperative follow-ups.
Conclusion: Both 25-gauge and 23 – gauge vitrectomies are minimally invasive and safe surgical techniques. 23 – gauge offers benefits of stiffer instruments and suitable for larger number of vitreo-retinal pathologies while 25 – gauge instruments are delicate and need careful handling. However, simpler vitreoretinal pathologies are better suited to 25 – gauge procedure.
Huma Kayani, Aamir Ahmed, Kashif Jahangir, Hizb-ur-Rehman, Khurram Chauhan. (2013) Comparison between 23 � Gauge and 25 � Gauge Pars Plana Vitrectomy for Posterior Segment Disease, Pakistan Journal of Ophthalmology, Volume 29, Issue 1.
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