gms | German Medical Science

24th Annual Meeting of the German Retina Society

German Retina Society

17.06. - 18.06.2011, Aachen

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Primary vitrectomy for rhegmatogenous retinal detachment in pseudophakic eyes: Is 20-gauge vitrectomy superior to transconjunctival 25-gauge vitrectomy?

Meeting Abstract

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  • Sabine Aisenbrey - Universitäts-Augenklinik Tübingen
  • I. Neuhann - Universitäts-Augenklinik Tübingen
  • P. Szurman - Universitäts-Augenklinik Tübingen; Augenklinik, Knappschaftskrankenhaus Sulzbach
  • K.U. Bartz-Schmidt - Universitäts-Augenklinik Tübingen

German Retina Society. 24th Annual Conference of the German Retina Society. Aachen, 17.-18.06.2011. Düsseldorf: German Medical Science GMS Publishing House; 2011. Doc11rg15

doi: 10.3205/11rg15, urn:nbn:de:0183-11rg151

This is the English version of the article.
The German version can be found at: http://www.egms.de/de/meetings/rg2011/11rg15.shtml

Published: June 15, 2011

© 2011 Aisenbrey et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.

Outline

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Purpose: To report anatomical and functional outcome of 20-gauge versus 25-gauge primary vitrectomy for complex rhegmatogenous retinal detachment in pseudophakic eyes.

Methods: Prospective single-centre randomized comparative trial designed to compare 20-gauge vitrectomy and sutureless 25-gauge vitrectomy in the treatment of pseudophakic patients with complex retinal rhegmatogenous detachment. Fifty patients with retinal detachment not complicated by PVR grade B or C and that cannot be treated with a single meridional sponge were randomized to either 20-gauge or 25-gauge vitrectomy, both without additional encircling band, as first surgical intervention. Primary endpoint was functional outcome (ETDRS BCVA) and secondary endpoint was anatomical outcome including retinal re-detachment, postoperative proliferative vitreoretinopathy (PVR), macular pucker, or macular edema (OCT) at six and 12 months.

Results: Mean visual acuity improved from 1.1 logMAR (20/250) to 0.3 logMAR (20/40) overall, in the 20-gauge group from 1.2 logMAR (20/320) to 0.3 logMAR (20/40), and from 1.0 logMAR (20/200) to 0.3 logMAR (20/40) in the 25-gauge group. Final anatomical success rate was 100% and primary success rate 80% at six months of follow-up. In the 20-gauge group the retina was attached after one single procedure in 19 eyes (76%), and in 21 eyes (84%) of the 25-gauge group. Macular edema was detected in three eyes in the 20-gauge group, and in one eye in the 25-gauge group. Additional surgery for visually significant macular pucker was performed in four eyes in the 20-gauge group and three eyes in the 25-gauge group.

Conclusions: Transconjunctival pars plana vitrectomy techniques are growing in popularity and are mainly used in macular diseases. The use of these systems in more complicated vitreoretinal procedures including the treatment of complex rhegmatogenous retinal detachment is controversial. In our series transscleral vitrectomy showed no disadvantage over 20-gauge vitrectomy in pseudophakic patients presenting with retinal detachment not suitable for single sponge surgery. Beneficial effect of additional encircling band was not evaluated in this study. From our data advantages of transconjunctival vitrectomy seem to overrule those of 20-gauge vitrectomy not only for macular procedures but also in the treatment of complex rhegmatogenous retinal detachment.