Transconjunctival cannulated PPV associated with reduced rate of intraoperative retinal tears

This retrospective study in the February issue of the Archives of Ophthalmology compares the development of intraoperative retinal breaks and postoperative rhegmatogenous retinal detachments (RRDs) in patients treated for macular pucker or macular hole with either 20-gauge standard pars plana vitrectomy (PPV) or transconjunctival cannulated PPV. The authors found a significantly reduced rate of intraoperative retinal tear formation with transconjunctival cannulated PPV, including 20-, 23- and 25-gauge transconjunctival systems, compared with standard 20-gauge PPV. Although there was a trend toward a lower rate of postoperative RRD following transconjunctival cannulated PPV compared with standard PPV, this reduction was not statistically significant.

The authors believe this to be the first study to find a statistically significant reduction in the rate of intraoperative retinal break formation using transconjunctival cannulated PPV.

They used data collected over a seven-year period from patients treated by five surgeons at one academic tertiary vitreoretinal practice. The authors identified 54 of 426 eyes (12.7 percent) followed for at least 60 days postoperatively that underwent vitrectomy and were diagnosed with new retinal tears intraoperatively.

Forty-seven of 204 patients (23 percent) undergoing the standard 20-gauge procedure developed intraoperative retinal tears compared with 7 of 211 patients (3.3 percent) undergoing the transconjunctival cannulated procedure (P < 0.001). However, patients who experienced intraoperative retinal tears were not at increased risk of developing postoperative RRD (P = 0.61).