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. 2013 Aug;27(8):952-8.
doi: 10.1038/eye.2013.118. Epub 2013 Jun 7.

23- vs 20-gauge pars plana vitrectomy in combination with bimanual microincisional cataract surgery (b-MICS) for the treatment of macular hole and cataract as a one-step procedure

C-L Schönfeld  1
Affiliations

23- vs 20-gauge pars plana vitrectomy in combination with bimanual microincisional cataract surgery (b-MICS) for the treatment of macular hole and cataract as a one-step procedure

C-L Schönfeld. Eye (Lond). 2013 Aug.

Abstract

Background/aims: 23-gauge pars plana vitrectomy (ppv) is a new method for vitreo-retinal surgery. It may reduce operation time, the risk of complications, and patient discomfort, especially in combination with simultaneous bimanual microincisional cataract surgery (b-MICS).

Methods: Seventy-five consecutive patients who underwent combined cataract surgery and ppv at our center between 1 January 2008 and 31 December 2010 were included. The first 36 patients were treated with 20-gauge ppv, the following 39 patients with 23-gauge ppv. Study end points 8 weeks after surgery were duration of the procedure, improvement of visual acuity, and occurrence of complications.

Results: Duration of surgery was reduced in 23- vs 20-gauge ppv (54.0 ± 11.6 vs 61.0 ± 19.0 min, P=0.08). Visual acuity improved significantly in both the groups (20-gauge: logMAR 0.750 ± 0.304 before and 0.369 ± 0.273 after surgery; 23-gauge: logMAR 0.663 ± 0.340 before and 0.339 ± 0.273 after surgery). There were no appreciable group differences in baseline or post-treatment visual acuity.

Conclusions: 23-gauge ppv in combination with b-MICS is a suitable, safe, and effective method for the treatment of combined cataract and vitreo-retinal diseases. The procedure is somewhat shorter and patient discomfort during and after surgery is improved. In terms of efficacy and safety, 23-gauge ppv is equivalent with conventional 20-gauge ppv.

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Figures

Figure 1
Figure 1
Macular hole stage at baseline in patients who underwent 20- or 23-gauge ppv, respectively.
Figure 2
Figure 2
Duration of the surgical procedure in patients who underwent 20- or 23-gauge ppv, respectively.
Figure 3
Figure 3
Visual acuity (logMAR) at baseline and 8 weeks after surgery in patients who underwent 20- or 23-gauge ppv, respectively. The y-scale was adapted to visualize the visual improvement (NS, not significant, ***P<0.0001).
Figure 4
Figure 4
Re-interventions in patients who underwent 20- or23-gauge ppv, respectively.
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