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Safety and Efficacy of
Transconjunctival Sutureless 23-Gauge Vitrectomy for Posterior
Segment Diseases
Ashraf M. El-Batarny
Ophthalmology Department, Faculty of Medicine, Tanta University,
Egypt
Tanta Med. Sc. J 2008; 3(2):145-155
Article type: Original article
Aim: To describe the initial experience, effectiveness, and safety
profile of 23-gauge instrumentation for a variety of vitreoretinal
conditions. Patients & Methods: A retrospective review of 30
consecutive 23-gauge vitrectomy cases done by a single vitreoretinal
surgeon for various posterior segment conditions was done. All
surgeries were performed using the two-step 23-gauge system
developed by Dutch Ophthalmic Research Center (DORC). All patients
had at least 3-month follow-up. Main outcome measures included
surgical success, visual acuity, intraocular pressure, and operative
complications. Results: Mean follow-up was 7.7 months (range 3–12
months). Indications for surgery included rhegmatogenous retinal
detachment (n =8), nonclearing vitreous hemorrhage (n =6),
tractional retinal detachment (n =5), macular hole (n=5), epiretinal
membrane (n=3), retained lens fragments (n=2) and endophthalmitis (n
=1). Gas tamponade was used in 18 eyes (60%) and silicone oil in six
eyes (20%). Mean overall preoperative visual acuity was 20/1053 and
final acuity was 20/78 (P = 0.001). Mean intraocular pressure after
6 hours was 15.1mmHg (range 4–25 mmHg) and on postoperative day one
was 14.5 mmHg (range 2–21 mmHg). Four eyes (13.3%) required suturing
of sclerotomy intraoperatively. Conversion to 20-gauge was done in
one eye (3.3%). Hypotony was reported in one eye (3.3%)
postoperatively. Subconjunctival silicone oil reported in one eye
(3.3%). There were no postoperative complications of endophthalmitis,
retinal or choroidal detachment. Conclusion: Twenty-three–gauge
transconjunctival sutureless vitrectomy was effective in the
management of wide variety of vitreoretinal surgical indications.
The safety profile compared favorably with published rates for
25-gauge systems.
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