Korean J Ophthalmol.  2012 Oct;26(5):339-346. 10.3341/kjo.2012.26.5.339.

Comparison of Efficacy and Safety between Transconjunctival 23-Gauge and Conventional 20-Gauge Vitrectomy Systems in Macular Surgery

• Goncu T
• Gurelik G
• Hasanreisoglu B

• KMID: 1397484
• DOI: http://doi.org/10.3341/kjo.2012.26.5.339

Abstract

PURPOSE
To compare the efficacy and safety of 23-gauge transconjunctival vitrectomy with the conventional 20-gauge method in idiopathic epiretinal membrane and macular hole surgery.
METHODS
Sixty-one consecutive patients undergoing vitrectomy for idiopathic epiretinal membrane and macular hole were recruited to either 20- or 23-gauge vitrectomy groups and prospectively evaluated. Surgical success rates, operating time, surgery-related complications, long-term visual outcomes, and postoperative ocular surface problems are compared in the two groups.
RESULTS
There were 31 eyes in the 20-gauge group and 33 eyes in the 23-gauge group. The macular hole closure rate after the first surgery was 83% and 90.9% in the 20-gauge and 23-gauge groups, respectively, with no significant difference between groups (p = 0.59). The success rate for idiopathic epiretinal membranes cases was 100% in both groups. There was no statistically significant difference between overall surgical times (p = 0.90). None of the patients in either group experienced postoperative complications of severe postoperative hypotony, vitreous hemorrhage or endophthalmitis, except one eye in the 20-gauge group, which was found to have retinal detachment. In both groups, statistically significant improvement in visual acuity was achieved 1-month postoperatively (p = 0.002) and thereafter at all postoperative visits (p < 0.05). The mean ocular surface scores were significantly lower in the 23-gauge group at all postoperative visits compared with the 20-gauge group scores (p = 0.001).
CONCLUSIONS
Transconjunctival 23-gauge vitrectomy appears to be as effective and safe as conventional 20-gauge vitrectomy in idiopathic epiretinal membrane and macular hole surgeries.

Keyword

Epiretinal membrane; Retinal perforations; Vitreoretinal surgery

MeSH Terms

Aged
Female
Humans
Male
Middle Aged
Operative Time
Postoperative Complications
Prospective Studies
Retinal Perforations/*surgery
Statistics, Nonparametric
Treatment Outcome
Visual Acuity
Vitrectomy/*methods

Figure

• 

  Fig. 1 Preoperative and postoperative logarithm minimum angle of resolution (logMAR) mean visual acuity (VA) observed in the 20-gauge and 23-gauge groups. In both groups, the VA improved significantly at all postoperative visits compared with preoperative values (Student's t-test, p < 0.05), and there was no significant difference in VA between the two groups preoperatively and postoperatively (Student's t-test, p > 0 .05).

• 

  Fig. 2 (A) Visual acuity (VA) at baseline and at 1 month, 3 months, 6 months, and final visits in the idiopathic epiretinal membrane subgroup of the 20- and 23-gauge groups. VA improved significantly at 1 month postoperatively (Student's t-test, p = 0.05 and p < 0.05, respectively) and at the final visit (Student's t-test, p = 0.006 and p = 0.003, respectively) in both groups. (B) VA at baseline and at 1 month, 3 months, 6 months, and final visits in the idiopathic macular hole subgroup of the 20- and 23-gauge groups. VA improved significantly at 1 month postoperatively (Student's t-test, p = 0.007 and p = 0.01, respectively) and at the final visit (Student's t-test, p = 0.002 and p = 0.035, respectively) in both groups. LogMAR = logarithm minimum angle of resolution.

• 

  Fig. 3 Preoperative and postoperative mean central macular thickness (CMT) measurements of the idiopathic epiretinal membrane patients in the 20- and 23-gauge vitrectomy groups. No significant differences related to the mean CMT value was seen between the two groups preoperatively or postoperatively (Student's t-test, p > 0.05). In both groups, the mean CMT was significantly reduced at 1 month, 3 months, 6 months, and the final postoperative visits compared with preoperative values (Student's t-test, p < 0.05).

• 

  Fig. 4 Preoperative and postoperative mean intraocular pressure (IOP) in the 20- and 23-gauge groups. The mean postoperative IOP of the 23-gauge group was significantly lower on postoperative day 1 compared with the 20-gauge group (Student's t-test, p = 0.01), but there was no significant difference between the mean IOP values of the two groups thereafter (Student's t-test, p > 0.05).

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