Outcomes of 140 Consecutive Cases of 25-Gauge Transconjunctival Surgery for Posterior Segment Disease

doi:10.1016/j.ophtha.2004.11.053

Ophthalmology

Volume 112, Issue 5, May 2005, Pages 817-824

Presented in part at: Association for Research in Vision and Ophthalmology annual meeting, Ft. Lauderdale, Florida, May 6, 2003.

https://doi.org/10.1016/j.ophtha.2004.11.053 Get rights and content

Purpose

To evaluate the safety and efficacy of 25-gauge instrumentation for a variety of vitreoretinal conditions on previously nonvitrectomized eyes.

Design

Single-center, retrospective, interventional case series.

Participants

One-hundred forty eyes of 140 patients were evaluated at the Doheny Retina Institute from July 2002 to July 2003.

Intervention

All patients underwent surgical procedures using the Millennium 25-gauge Transconjunctival Standard Vitrectomy system. Twenty eyes (14.3%) underwent procedures without vitrectomy.

Main Outcome Measures

Postoperative visual acuity (VA), intraocular pressure, surgical time, postoperative inflammation, complications, and number of sutured sites.

Results

No intraoperative complications were noted. No cases required conversion to 20-gauge machines. Ten cases (7.1%) involved single-site sclerotomy suture placement due to bleb formation at the conclusion of the procedure, but 5 of these entry sites were enlarged to facilitate larger instrumentation for tissue manipulation. Median VA improved from 20/250 (logarithm of the minimum angle of resolution, 1.08±0.47) preoperatively to 20/60 (0.47±0.30) (P<0.0001) at final visit. Mean follow-up was 33.8±9.7 weeks, and all eyes were observed for a minimum of 12 weeks. Mean total surgical time was 17.4±6.9 minutes. Intraocular pressures remained stable throughout the postoperative course. Five eyes (3.8%) presented on day 1 with shallow choroidal detachments, but all resolved by day 7, and none required volume infusion during the postoperative period. All but one of these cases was within the first 50 procedures performed. No detectable inflammation was noted in any eyes by 4 weeks postoperatively. No case of retinal detachment or endophthalmitis was recorded.

Conclusions

Transconjunctival surgery using 25-gauge instrumentation may hasten postoperative recovery by decreasing overall surgical time and postoperative inflammation. Procedures requiring minimal intraocular manipulation did not require sutures and, thus, may be better suited for this surgical modality.

Section snippets

Patients and Methods

Institutional review board approval to review patient data was obtained for this study, all patients signed an informed consent form before intervention, and all data were collected in accordance with compliance guidelines outlined by the Health Insurance Portability and Accountability Act of 1996.

We retrospectively reviewed a consecutive series of 140 nonvitrectomized eyes of 140 patients who underwent 25-gauge transconjunctival posterior segment surgical procedures performed by 5 surgeons

Results

Overall results are summarized in Table 1. Overall, 71 men and 69 women, with a median age of 67 years (mean, 67.1±13.7 [standard deviation]), were observed for a mean of 33.8±9.7 weeks. Minimum follow-up time was 12 weeks. Median preoperative VA was 20/250 (logMAR, 1.08±0.47), and median postoperative VA at final visit was 20/60 (0.47±0.3) (P<0.0001) (Fig 1). Mean preoperative IOP was 16.3±4.1 mmHg, and mean postoperative IOPs at 1 day, 1 week, and final visit were 15.9±6.2 (P = 0.46),

Discussion

Minimally invasive vitreoretinal surgery has been proposed in the past by other authors.6, 7, 8, 9, 10, 11 Chen¹² proposed sutureless tunnel-based sclerotomies, but his series revealed difficulty in passage of conventional instrumentation along with several complications, including wound extension, dehiscence, and leakage; vitreous and/or retinal incarceration; hemorrhage; retinal tears; and dialysis.6, 9, 12 Also, although these were touted to be minimally invasive, conjunctival dissection and

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Manuscript no. 240527.

Supported in part by National Institutes of Health, Bethesda, Maryland (grant for vision research no.: EY03040).

The Transconjunctival Standard Vitrectomy system is manufactured by Bausch & Lomb Surgical (San Dimas, CA). The MADLAB (EDJ, ACB) may receive royalties related to the sale of this and other instruments mentioned. Any royalty received as a result of the sale of these instruments is given to the MADLAB to defray operating costs. No other authors have any proprietary interest in any of the instruments mentioned in the article.

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Original articleOutcomes of 140 Consecutive Cases of 25-Gauge Transconjunctival Surgery for Posterior Segment Disease

Purpose

Design

Participants

Intervention

Main Outcome Measures

Results

Conclusions

Section snippets

Patients and Methods

Results

Discussion

J Am Intraocul Implant Soc

J Cataract Refract Surg

Am J Ophthalmol

Am J Ophthalmol

Ophthalmology

Ophthalmology

J Cataract Refract Surg

The advantages and disadvantages of Kelman phacoemulsification (KPE)

Ophthalmology

Quantitative assessment of postsurgical breakdown of the blood-aqueous barrier

Arch Ophthalmol

Original article
Outcomes of 140 Consecutive Cases of 25-Gauge Transconjunctival Surgery for Posterior Segment Disease