MAR 16, 2018
Retina/Vitreous
This retrospective, multicenter case series examined the long-term visual outcomes of 27-gauge pars plana vitrectomy in patients with posterior segment disease.
Study design
The authors examined postoperative visual acuity and complications in 390 eyes that underwent vitrectomy with 27-gauge instrumentation. Cases involving multiple-gauge instrumentation or concurrent glaucoma or corneal surgery were excluded. Patients who underwent concurrent phacoemulsification were included in the study.
Outcomes
Overall logMAR visual acuity improved from 0.72 to 0.40 over an average follow-up period of 715 days (minimum follow-up of 365 days). Statistically significant visual improvements were noted in patients with epiretinal membrane, macular hole, vitreous hemorrhage, diabetic tractional detachment, retained lens material and endophthalmitis.
Transient postoperative hypotony occurred in 5.6% of eyes and was statistically associated with angled sclerotomy incisions or a history of vitrectomy. Notable postoperative complications included ocular hypertension (10.8%), vitreous hemorrhage (7.9%), cystoid macular edema (3.6%), recurrent PVR detachment (1.5%), primary retinal detachment (0.78%) and endophthalmitis (0.26%).
Limitations
The decision to use 27-gauge instrumentation was left to the surgeon’s discretion, so this study may have been biased toward less severe cases. Cases involving primary retinal detachment repair were relatively underrepresented in the dataset. The rates of postoperative vitreous hemorrhage (7.9%) and postoperative transient hypotony (5.6%) might be a little higher than expected. There was limited standardization of surgical technique between the surgeons.
Clinical significance
This series provides some support for the long-term effectiveness and safety of 27-gauge vitrectomy instrumentation by demonstrating a complication rate generally comparable to that of 23- and 25-gauge surgery. Wound construction in 27-gauge vitrectomy deserves further investigation.