Abstract
Background
To compare the incidence of intraoperative iatrogenic peripheral retinal breaks (IPRBs) during 23-gauge transconjunctival sutureless vitrectomy (TSV) and conventional 20-gauge vitrectomy for various indications.
Methods
This was a single-center, comparative, retrospective, interventional case series of 973 23-gauge TSVs and 402 conventional 20-gauge vitrectomies done by two surgeons between January 2004 and December 2009. The incidence rate of intraoperative IPRBs and risk factors were analyzed in association with various clinical and surgical factors.
Results
IPRBs occurred significantly less often during 23-gauge TSV (16 of 973 cases, 1.6 %) than during conventional vitrectomy (25 of 402 cases, 6.2 %, P < 0.001). Univariate analysis revealed that conventional vitrectomy and operation time were risk factors for the complication. Multivariate logistic regression analysis also revealed that conventional vitrectomy (P = 0.03, OR = 2.91), operation time (P < 0.01, OR = 1.01), and intraoperative induction of posterior vitreous detachment (PVD, P = 0.04, OR = 1.97) were risk factors for IPRBs.
Conclusions
The 23-gauge TSV procedure with the trocar system has a lower incidence of intraoperative IPRBs than conventional 20-gauge vitrectomy. Longer operation time and induction of PVD are also independent risk factors of the complication.
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References
Fujii GY, De Juan E Jr, Humayun MS, Chang TS, Pieramici DJ, Barnes A, Kent D (2002) Initial experience using the transconjunctival sutureless vitrectomy system for vitreoretinal surgery. Ophthalmology 109:1814–1820
Eckardt C (2005) Transconjunctival sutureless 23-gauge vitrectomy. Retina 25:208–211
Misra A, Ho-Yen G, Burton RL (2009) 23-gauge sutureless vitrectomy and 20-gauge vitrectomy: a case series comparison. Eye 23:1187–1191
Warrier SK, Jain R, Gilhotra JS, Newland HS (2008) Sutureless vitrectomy. Indian J Ophthalmol 56:453–458
Spirn MJ (2009) Comparison of 25, 23 and 20-gauge vitrectomy. Curr Opin Ophthalmol 20:195–199
Moore JK, Kitchens JW, Smiddy WE, Mavrofrides EC, Gregorio G (2007) Retinal breaks observed during pars plana vitrectomy. Am J Ophthalmol 144:32–36
Al-Harthi E, Abboud EB, Al-Dhibi H, Dhindsa H (2005) Incidence of sclerotomy-related retinal breaks. Retina 25:281–284
Ramkissoon YD, Aslam SA, Shah SP, Wong SC, Sullivan PM (2010) Risk of iatrogenic peripheral retinal breaks in 20-G pars plana vitrectomy. Ophthalmology 117:1825–1830
Chung SE, Kim KH, Kang SW (2009) Retinal breaks associated with the induction of posterior vitreous detachment. Am J Ophthalmol 147:1012–1016
Tan HS, Mura M, de Smet MD (2009) Iatrogenic retinal breaks in 25-gauge macular surgery. Am J Ophthalmol 148:427–430
Tan HS, Lesnik Oberstein SY, Mura M, de Smet MD (2010) Enhanced internal search for iatrogenic retinal breaks in 20-gauge macular surgery. Br J Ophthalmol 94:1490–1492
Patelli F, Radice P, Zumbo G, Frisone G, Fasolino G (2007) 25-gauge macular surgery: results and complications. Retina 27:750–754
Rezeq SS, Vander JF, Hsu J, Regillo CD, Ho AC, Garg SJ, Spirn MJ (2011) Iatrogrenic retinal breaks. Ophthalmology 118:1696, 1696.e1; author reply 1697
Tewari A, Shah GK, Fang A (2008) Visual outcomes with 23-gauge transconjunctival sutureless vitrectomy. Retina 28:258–262
Gupta OP, Ho AC, Kaiser PK, Regillo CD, Chen S, Dyer DS, Dugel PU, Gupta S, Pollack JS (2008) Short-term outcomes of 23-gauge pars plana vitrectomy. Am J Ophthalmol 146:193–197
Fine HF, Iranmanesh R, Iturralde D, Spaide RF (2007) Outcomes of 77 consecutive cases of 23-gauge transconjunctival vitrectomy surgery for posterior segment disease. Ophthalmology 114:1197–1200
Scartozzi R, Bessa AS, Gupta OP, Regillo CD (2007) Intraoperative sclerotomy-related retinal breaks for macular surgery, 20- vs 25-gauge vitrectomy systems. Am J Ophthalmol 143:155–156
Nakano T, Uemura A, Sakamoto T (2011) Incidence of iatrogenic peripheral retinal breaks in 23-gauge vitrectomy for macular diseases. Retina 31:1997–2001
Issa SA, Connor A, Habib M, Steel DH (2011) Comparison of retinal breaks observed during 23 gauge transconjunctival vitrectomy versus conventional 20 gauge surgery for proliferative diabetic retinopathy. Clin Ophthalmol 5:109–114
Kim MJ, Park KH, Hwang JM, Yu HG, Yu YS, Chung H (2007) The safety and efficacy of transconjunctival sutureless 23-gauge vitrectomy. Korean J Ophthalmol 21:201–207
Woo SJ, Park KH, Hwang JM, Kim JH, Yu YS, Chung H (2009) Risk factors associated with sclerotomy leakage and postoperative hypotony after 23-gauge transconjunctival sutureless vitrectomy. Retina 29:456–463
Territo C, Gieser JP, Wilson CA, Anand R (1997) Influence of the cannulated vitrectomy system on the occurrence of iatrogenic sclerotomy retinal tears. Retina 17:430–433
Wimpissinger B, Binder S (2007) Entry-site-related retinal detachment after pars plana vitrectomy. Acta Ophthalmol Scand 85:782–785
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Cha, D.M., Woo, S.J., Park, K.H. et al. Intraoperative iatrogenic peripheral retinal break in 23-gauge transconjunctival sutureless vitrectomy versus 20-gauge conventional vitrectomy. Graefes Arch Clin Exp Ophthalmol 251, 1469–1474 (2013). https://doi.org/10.1007/s00417-013-2302-y
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DOI: https://doi.org/10.1007/s00417-013-2302-y