http://www.evrs.eu/medias/2006/congress/23-Gauge-Vitrectomy-as-an-Effective-and-Safe-Alternative-for-Sutureless-Vitreous-Surgery.swf

Keith A. Warren, MD (Overland Park, KS)

PURPOSE:

To evaluate the safety and effectiveness of the 23-gauge vitrectomy system (DORC) as a treatment modality for a variety of Vitreoretinal surgical disorders.

METHODS:

Seventy-three(73) Patients with a wide range of retinal pathology were treated using the 23gauge vitrectomy system. All patients were pretreated with a fourth generation flouroquinolone and then underwent a standard three port vitrectomy. Patients were followed for a minimum of three months and outcomes evaluated included; complications, postoperative intraocular pressure (IOP), anatomic restoration, and conversion to 20 gauge vitrectomy.

RESULTS:

DisorderType Patient Number (n) Primary Retinal Detachment (14), Diabetic Tractional Detachment (19), Diabetic Vitreous Hemorrhage (23), Macular Hole (9), Macular Pucker (4), Diabetic CME (1), BRVO/Hemorrhage/ERM (1), Peripapillary CNVM (1), Subfoveal Hemorrhage (1) Significant complications occurred in 5 of 73 patients (6.84%) and included vitreous hemorrhage (2), peripheral retinal tear (2), and cataract (1). 8 of 73 Patients (10.95%) had minor subconjunctival hemorrhages and 2 of 73  (2.74%) had subconjunctival gas. Mean postoperative IOP was 14 with a range of 4 to 28. 2 patients (2.74%) had IOP of 5 or less on post-op day 1. 4 (5.49%) patients did require conversion to 20-gauge vitrectomy, while all patients had successful  anatomic restoration with a single operation.

CONCLUSION:

23 ga vitrectomy provides an excellent alternative treatment modality for sutureless surgery in patients with a wide variety of retinal pathology. It appears to have a low complication rate. Mean post operative pressures were normal. The properties of the intermediate gauge size including increased fluid flow and instrument rigidity may offer some advantages over other size instrumentation.