Outcomes of small-gauge vitreoretinal surgery without scleral-depressed shaving of the vitreous base in the era of wide-angle viewing systems. Issue 12 (15th February 2019)

• Record Type: Journal Article
• Authors: Tabandeh, Homayoun; London, Nikolas J S; Boyer, David S; Flynn Jr, Harry W
• Is Part Of: British journal of ophthalmology. Volume 103:Issue 12(2019)
• Page Start: 1765
• Page End: 1768
• Publication Date: 2019-02-15
• Subjects: retinal detachment -- microincision small gauge pars plana vitrectomy -- 23 25 and 27 gauge vitrectomy -- scleral depression -- vitreous shave; Ophthalmology -- Periodicals; 617.7
• DOI: 10.1136/bjophthalmol-2018-313626
• Languages: English
• ISSNs: 0007-1161

Abstract

Abstract : Purpose: To evaluate outcomes of small-gauge pars plana vitrectomy (PPV) for the treatment of rhegmatogenous retinal detachment (RD) without scleral-depressed shaving of the vitreous base. Methods: Retrospective, consecutive case series. Surgical technique included small-gauge PPV (25G, 23G, 25G+ or 27G) and wide-angle vitrectomy viewing system in all cases. No cases were excluded based on the level of complexity of RD. Outcome measures were retinal reattachment rates and Snellen visual acuity (best-corrected visual activity [BCVA]). Results: 312 eyes of 301 patients, mean age 60.8 years, and mean follow-up 23.1 months. Baseline characteristics included macula-off RD in 207 (66%) eyes, psudophakia in 124 (40%) eyes, high myopia in 74 (24%) eyes and giant retinal tear in 14 (5%) eyes. The retina was reattached with one procedure in 296 (95%) eyes. Final retinal reattachment was achieved in 310 (99%) eyes. The BCVA at baseline was >20/40 in 76 (24%) eyes, 20/50–20/100 in 48 (15%) eyes, 20/200–20/400 in 46 (15%) eyes and <20/400 in 142 (46%) eyes. At the last follow-up, the BCVA was >20/40 in 168 (54%) eyes, 20/50–20/100 in 60 (19%) eyes, 20/200–20/400 in 49 (16%) eyes and <20/400 in 35 (11%) eyes. The mean change in logMAR equivalent was −0.12 for the macula-on group and −1.13 for the macula-off group (p<0.0001). Conclusion: Small-gauge PPV without scleral-depressed vitreous base shaving can be associated with good anatomical and visual outcomes. Case selection based on the complexity of RD may not be required when considering small-gauge PPV.