ABSTRACT

Purpose:

The aim of our presentation is to compare a conventional 20ga technique and 23ga suturless vitrectomy (PPV) in patients who underwent surgery for diagnosis of macular holes.
Two cohorts of patients were processed. The first group of patients underwent surgery between 2003 and 2005 with a classic 20ga PPV. The second group of patients was between 2013 and 2018, who underwent surgery with a technique of suturless 23ga PPV.
The second part of our presentation compares conventional 20ga technique and 23ga suturless vitrectomy (PPV) in the surgical treatment of epiretinal membranes. The comparison was performed between2004 and 2009 by a 20ga vitrectomy PPV. The second group of patients was operated between 2010 and 2018 with a 23ga suturless PPV.

Materials & Methods:

Macular hole:
Surgery of the macular hole was indicated in patients diagnosed with a macular hole of a Gasse stage 2, 3 and 4 using biomicroscopic and OCT examinations. Stages 1a and 1b were indicated for surgery only when a complete macular hole of stage 2 – 4 was diagnosed in the second eye.
In the first group of patients who underwent surgery between 2003 and 2005 by 20ga PPV, 54 eyes of 52 patients were included. The mean age of the enrolled patients was 68 years. The average follow-up was 14 months. All patients were preoperatively diagnosed with idiopathic macular holes of stages 2 – 4 with an elevation of edges, 6 eyes (11%) were pseudophakic before PPV surgery.
In the second group of patients (2013-2018) we performed surgery in 74 eyes of 73 patients by 23ga suturless PPV. The average age of the patients in this group was 71 years. The mean follow-up was 7 months. All patients were preoperatively diagnosed with idiopathic macular holes of stage 2 – 4 with an elevation of edges, 35 eyes (44%) were pseudophakic prior to PPV surgery.

Epiretinal membrane:
In the first group of patients (20ga) operated between 2004-2009, 159 eyes of 159 patients were included. The mean age of the enrolled patients was 66.5 ± 9.4 years. The mean follow-up was 12 months. All idiopathic epimacular membranes were diagnosed with scarring and thickening, which was verified by OCT examination. 18 eyes (11%) were pseudophakic before epiretinal surgery.
In the second group (23ga) between 2010 and 2018, 211 eyes of 211 patients underwent surgery. The mean age of the patients was 65.8 ± 8.5 years. All idiopathic epimacular membranes were diagnosed with scarring and thickening, which was verified by OCT examination. The mean follow-up was 20.5 months (6-60 months). Preoperative pseudophakia was present in 40 eyes (19%).

Results:

Macular hole:
In the first group (20ga PPV) the mean UCVA before surgery was 0.94 Log MAR (4/40, 20/200). The mean UCVA after surgery was at 0.58 (4/16, 20/80). This means that visual acuity has improved by an average of 4 ETDRS lines (20 letters). Idiopathic macular hole was sealed in 51 eyes (94%),remained open with elevated margins only in 3 eyes(6%).
In the second group of patients the mean UCVA before surgery was 0.72 Log MAR (4/20, 20/100). The mean UCVA after surgery was at 0.56 (4/16, 20/80). This means that visual acuity improved by an average of 2 ETDRS lines (10 letters). Idiopathic macular holes closed at 66 eyes (89%), remained open with elevated margins in 8 eyes (11%).

Epiretinal membrane:
In the first group (20ga PPV) was pre-operative UCVA at 0.76 logMAR (4/25). After surgery, it improved to 0.40 LogMAR (4/10). The results of the visual acuity were processed using a pairwise Student t-test. A statistically significant difference was found (p = 0.001). In fact, the best corrected visual acuity improved on average by 4 lines of the ETDRS optotype. Preoperative metamorphopsies were eliminated after surgery in 127 patients (80%) during the follow-up period.
In the second group (23ga PPV) UCVA was pre-operatively at 0.70 logMAR (4/20). After surgery, it improved to 0.35 LogMAR (4/8). The results of the visual acuity were processed using a pairwise Student t-test. A statistically significant difference was found (p = 0.001). In fact, the best corrected visual acuity improved on average by 4 lines of the ETDRS optotype. Preoperatively metamorphopsies diminished in 178 patients (84%) at the end of the follow-up period.

Conclusions:

20ga and 23ga PPV supplemented by internal limiting membrane peeling and expansion gas tamponade is a safe method for treating idiopathic macular holes. Peeling of idiopathic epimacular membranes via PPV is a method of choice in the treatment of this clinical unit. Modern vitreoretinal technology along with trypan blue dye makes this treatment method highly effective and safe. According to our results, it is a safe treatment method in which patients on average will improve visual acuity by 4 rows of ETDRS optotype. We did not prove a significant difference in the results between the two techniques. On the other hand a suturless approach is accelerating and much more comfortable aswell as patient friendly..


CONTACT DETAILS

 

Petr Kolář
Department of Ophthalmology, Slovak Medical University and University Hospital Bratislava, Slovakia
Department of Ophthalmology, Masaryk University Brno and University Hospital Brno, Czech Republic