gms | German Medical Science

23 g vitrectomy was performed initially in eyes with macular holes and epiretinal membranes. Since safety and skills improved, 23g vitrectomy is used for retinal detachments and diabetic cases. In addition to affording an efficacy equivalent to 20-gauge surgery, 23-gauge surgery also shares most of 25-gauge surgery's safety advantages, but facilitates more stable instruments.The study was designed as an uncontrolled, consecutive case series. In 22 eyes of 22 patients with retinal detachment a transconjunctival 23g vitrectomy was performed. Mean age of the patients was 64 years (41 to 82 years) 7 women and 15 men were evaluated. 9 eyes had cataract surgery with intraocular lens implantation within the last 5 years. All procedures were performed in retrobulbar anaesthesia, using the BIOM and a combined infusion cannula with xenon illumination (synergetics). One step trocars (Alcon) with machined disposable titanium cannulas were used. In all but two eyes heavy liquids were used to attach the retina for photolasercoagulation of the tear or hole(s). Fluid-air exchange was the final step in all surgeries before removing the trocars. Head down position was required for 4 hours, after this time, position of the head due to the place of the retinal hole was recommended.Seven eyes out of 22 required a second procedure due to retinal redetachment after a main observation period of 5 months. One eye was operated three times and complete anatomical success was achieved. Only one eye presented with intraocular pressure under 10mmHg at the first postoperative day. In 11 eyes IOP was between 12 and 23 mmHg at the first day after surgery. In four eyes a mild hyphaema was observed due to the head down position required at the first nightIn this small case study no difference to the recent evaluation of our redetachment rate was observed. The benefit of transconjunctival 23g vitrectomy in retinal detachment for patients are the higher postoperative comfort without sutures and shorter time of surgery. The advantages of the 23-gauge vitrectomy include its more rigid instrumentation and its flow dynamics, which are essentially the same as those of a 20-gauge system. In addition, 23-gauge procedures do not require sutures and, in the case of the vitrectomy system, described before, the 23-gauge vitreous cutter is similar in efficacy to the 20-gauge cutter and in many respects better.No pain or other severe complications were documented. Since there was no gas used, no high IOP was measured. From our findings no difference to conventional 20g vitrectomy was seen. Although prospective studies are necessary, transconjunctival 23g vitrectomy in retinal detachment seems to be a comparable and appropriate method.