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. 2020 Jan 31:14:299-305.
doi: 10.2147/OPTH.S233884. eCollection 2020.

Hybrid 23/27 Gauge Vitrectomy - Combining the Charm of 27G with the Efficacy of 23G

Justus G Garweg  1   2 , Dean Ouassi  3 , Isabel B Pfister  1
Affiliations

Hybrid 23/27 Gauge Vitrectomy - Combining the Charm of 27G with the Efficacy of 23G

Justus G Garweg et al. Clin Ophthalmol. .

Abstract

Background: Minimally invasive transconjunctival sutureless vitrectomy (MIVS) has evolved into the standard of care, smaller incisions thought to result in lower ocular surface trauma and shorter times to recovery. The currently most relevant limitations in macular surgery may be light intensity and 27G instrument stability. Therefore, we thought to compare standard 23 and 27G vitrectomy with a hybrid technique using one 23G and two 27G ports regarding surgical times and short-term outcomes.

Methods: This retrospective comparison included 90 single-center consecutive cases of eyes undergoing elective micro-invasive vitrectomy for epiretinal membranes or idiopathic macular holes between October 2017 and June 2018. The main criteria for the comparison were total surgical time as primary outcome parameter and treatment-demanding intra- and postoperative complications along with recovery of best-corrected visual acuity (BCVA) and central retinal thickness (CRT) from prior to surgery to 1 month thereafter as secondary parameters as independent parameters for the recovery from the pre-existing pathology and the surgical trauma.

Results: Surgical times were shorter with 23G and 23/27G compared to 27G (23G: 38.4±13.1; 27G: 48.1±15.3; 23/27G: 34.9±9 mins; p=0.0005) with no differences in BCVA and CRT outcomes. Switching from 27G to a larger port size was not necessary in any instance. Cryotherapy was applied in 15%, 30%, and 22.5% to suspected retinal pathologies, beyond these, in 5%, 0%, and 7.5% for retinal tears. Four postoperative retinal detachments occurred (4.4%), one in the 23G and three in the 23/27G group requiring re-vitrectomy.

Conclusion: In this exploratory case series, 23/27G hybrid vitrectomy, combining the advantages of 23G and 27G techniques, resulted in shorter surgical times without evident disadvantages. The combination with cataract surgery was unproblematic.

Keywords: 27-gauge; epiretinal membrane; hybrid; inner limiting membrane; peeling; surgical time; vitrectomy.

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Conflict of interest statement

JGG is an adviser for several pharmaceutical companies (Alcon, Allergan, Bayer, Novartis) and participates in a number of international multicenter clinical studies in the fields of AMD and diabetic retinopathy that have received sponsors by industry partners (Novartis, Bayer). These activities had no bearing on the study that gave rise to the submitted article, for which JGG received neither direct nor indirect financial support; nor has he conflicts of interest with any of the presented data. The remaining authors report no potential conflicts of interest.

Figures

Figure 1
Figure 1
23G versus 27G and hybrid 23/27G minimally invasive vitrectomy: surgical times for vitrectomy (those procedures that had been combined with cataract surgery were included after subtracting the estimated average duration of 8 mins for cataract component).
Figure 2
Figure 2
23G versus 27G and hybrid 23/27G minimally invasive vitrectomy: evolution of best-corrected visual acuity from before until 1 month after surgery. There were no significant differences between the groups.
See this image and copyright information in PMC

References

    1. Aydin B, Dinç E, Yilmaz SN, et al. Retinal endoilluminator toxicity of xenon and light-emitting diode (LED) light source: rabbit model. Cutan Ocul Toxicol. 2014;33:192–196. doi:10.3109/15569527.2013.832282 - DOI - PubMed
    1. Barthelmes D, Alexander S, Mitchell P, Chandra J. Hybrid 20/23-gauge pars plana vitrectomy for retained lens fragments after cataract surgery. Retina. 2012;32:1749–1755. doi:10.1097/IAE.0b013e3182453309 - DOI - PubMed
    1. Cruz-Iñigo YJ, Berrocal MH. Twenty-seven-gauge vitrectomy for combined tractional and rhegmatogenous retinal detachment involving the macula associated with proliferative diabetic retinopathy. Int J Retina Vitreous. 2017;3:38. doi:10.1186/s40942-017-0091-x - DOI - PMC - PubMed
    1. de Oliveira PR, Berger AR, Chow DR. Vitreoretinal instruments: vitrectomy cutters, endoillumination and wide-angle viewing systems. Int J Retina Vitreous. 2016;2:28. doi:10.1186/s40942-016-0052-9 - DOI - PMC - PubMed
    1. Dikopf MS, Patel KH, Setlur VJ, Lim JI. Surgical outcomes of 25-gauge pars plana vitrectomy for diabetic tractional retinal detachment. Eye (Lond). 2015;29:1213–1219. doi:10.1038/eye.2015.126 - DOI - PMC - PubMed