Intraoperative iatrogenic peripheral retinal break in 23-gauge transconjunctival sutureless vitrectomy versus 20-gauge conventional vitrectomy

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.