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23 Gauge versus 20 Gauge System for Pars Plana Vitrectomy: A Prospective Randomized Clinical Trial
  1. Barbara Wimpissinger (barbara.wimpissinger{at}gmx.at),
  2. Lukas Kellner (lukas.kellner{at}wienkav.at),
  3. Werner Brannath (werner.brannath{at}meduniwien.ac.at),
  4. Katharina Krepler (katharina.krepler{at}wienkav.at),
  5. Ulrike Stolba (ulrike.stolba{at}wienkav.at),
  6. Christian Mihalics (christian.mihalics{at}wienkav.at),
  7. Susanne Binder (susanne.binder{at}wienkav.at)
  1. Department of Ophthalmology, Rudolph Foundation Clinic, Vienna
  2. Department of Ophthalmology, Rudolph Foundation Clinic, Vienna
  3. Section of Medical Statistics, Medical University of Vienna
  4. Department of Ophthalmology, Rudolph Foundation Clinic, Vienna
  5. Department of Ophthalmology, Rudolph Foundation Clinic, Vienna
  6. Department of Ophthalmology, Rudolph Foundation Clinic, Vienna
  7. Department of Ophthalmology, Rudolph Foundation Clinic, Vienna

    Abstract

    Aim: To compare the sutureless 23-gauge system to a standard 20-gauge system in pars plana vitrectomy.

    Methods: 60 patients in 2 randomized groups were included in this prospective clinical trial. Pars plana vitrectomy with either 23 or 20 gauge instruments was performed. Main outcome measures were postoperative conjunctival injection and pain. Secondary outcome parameters were time of surgery, intraocular pressure, visual acuity, and complications.

    Results: Conjunctival injection (p=0.0003) and postoperative pain (p=0.01) were significantly reduced following 23 gauge vitrectomy compared to the 20 gauge procedure. Opening (p=0.006) and closure times (p<0.00001) were significantly shorter, vitrectomy time (p=0.001) significantly longer in the 23 gauge system compared to 20 gauge vitrectomy. However, retinal manipulation and overall surgery times did not differ significantly between both groups. The same applies for eye pressure, distance, and reading acuity. Regarding complications, two choroidal hemorrhages and one flat serous choroidal detachment occurred in the 23 gauge group.

    Conclusion: The 23 gauge system for pars plana vitrectomy offers significantly higher patient comfort during the early postoperative period. Time of surgery is almost equal - shorter time for wound closure is neutralized by longer vitrectomy time in the 23 gauge group.

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