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. 2018 Mar 18;11(3):408-415.
doi: 10.18240/ijo.2018.03.10. eCollection 2018.

Outcomes of transconjunctival sutureless 27-gauge vitrectomy for vitreoretinal diseases

Jie Li  1 , San-Mei Liu  1 , Wen-Tao Dong  1 , Fang Li  1 , Cai-Hong Zhou  1 , Xiao-Dan Xu  1 , Jie Zhong  1
Affiliations

Outcomes of transconjunctival sutureless 27-gauge vitrectomy for vitreoretinal diseases

Jie Li et al. Int J Ophthalmol. .

Abstract

Aim: To evaluate the safety and efficacy profile of 27-gauge (27G) pars plana vitrectomy (PPV) for the treatment of various vitreoretinal diseases.

Methods: The clinical outcomes of 61 eyes (58 patients) with various vitreoretinal diseases following 27G PPV were retrospectively reviewed.

Results: Surgical indications included rhegmatogenous retinal detachment (n=24), full-thickness macular hole (n=12), diabetic retinopathy (n=11), vitreous hemorrhage (n=6), Eales disease (n=4), pathological myopia-related vitreous floater (n=2), and macular epiretinal membrane (n=2). The mean follow-up was 166.4±61.3d (range 98-339d). The mean logMAR best-corrected visual acuity (BCVA) improved from 1.7±1.1 [0.02 decimal visual acuity (VA) equivalent] preoperatively to 1.2±1.0 (0.06 decimal VA equivalent) at the last postoperative visit (P<0.001). The mean operative time was 49.9min. With the exception of complicated cataract in one eye, no intraoperative complications were encountered. No case required conversion to conventional 20-, 23- or 25G instrumentation in all surgical maneuvers except for silicone oil infusion, which required a 25G oil injection syringe. Postoperative complications included transient ocular hypertension, vitreous hemorrhage, persistent intraocular pressure elevation, subconjunctival oil leakage, and recurrent retinal detachment. No cases of hypotony, endophthalmitis, and sclerotomy-related tears were observed.

Conclusion: The current results suggest that 27G PPV system is a safe and effective treatment for various vitreoretinal diseases. When learning to perform 27G PPV, surgeons may encounter a learning curve and should gradually expand surgical indications from easy to pathologically complicated cases.

Keywords: 27-gauge; par plana vitrectomy; vitreoretinal disease.

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Figures

Figure 1
Figure 1. Outcomes of 27G vitrectomy surgery in 61 eyes: mean logMAR VA by diagnosis.
Figure 2
Figure 2. Outcomes of 27G vitrectomy surgery in 61 eyes: mean operative time by diagnosis.
Figure 3
Figure 3. Changes in the mean operative time
The mean operative time of the same surgeon (Zhong J) using 27G microincision vitrectomy to treat various vitreoretinal diseases was gradually shortened.
Figure 4
Figure 4. Operative time used to treat RRD
Twenty-four eyes diagnosed with RRD were equally divided into two groups. The mean operative time used to treat the first half (group 1, n=12) of RRD cases was 63.8±7.2min, which was significantly shorter than that (44.5±5.0min) used to treat the second half (group 2, n=12), P=0.04.
Figure 5
Figure 5. Changes in the composition of the surgical indication
Over time, the proportion of macular surgery (including MEM and FTMH) decreased; by contrast, the ratio of RRD treated with 27G vitrectomy increased dramatically. MS: Macular surgery; RRD: Rhegmatogenous retinal detachment.
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