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  • Outcomes of small-gauge vitreoretinal surgery without scleral-depressed shaving of the vitreous base in the era of wide-angle viewing systems

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Clinical science
Outcomes of small-gauge vitreoretinal surgery without scleral-depressed shaving of the vitreous base in the era of wide-angle viewing systems
  1. Homayoun Tabandeh1,
  2. Nikolas J S London2,
  3. David S Boyer3,
  4. Harry W Flynn Jr4
  1. 1 Retina-Vitreous Associates Medical Group, Los Angeles, California, USA
  2. 2 Retina Consultants San Diego, Poway, California, USA
  3. 3 Retina-Vitreous Associates Medical Group, Los Angeles, California, USA
  4. 4 Ophthalmology, Bascom Palmer Eye Institute, Miami, Florida, USA
  1. Correspondence to Dr Homayoun Tabandeh, Retina-Vitreous Associates Medical Group, Los Angeles, CA 90211, USA; tabandeh100{at}gmail.com

Abstract

Purpose To evaluate outcomes of small-gauge pars plana vitrectomy (PPV) for the treatment of rhegmatogenous retinal detachment (RD) without scleral-depressed shaving of the vitreous base.

Methods Retrospective, consecutive case series. Surgical technique included small-gauge PPV (25G, 23G, 25G+ or 27G) and wide-angle vitrectomy viewing system in all cases. No cases were excluded based on the level of complexity of RD. Outcome measures were retinal reattachment rates and Snellen visual acuity (best-corrected visual activity [BCVA]).

Results 312 eyes of 301 patients, mean age 60.8 years, and mean follow-up 23.1 months. Baseline characteristics included macula-off RD in 207 (66%) eyes, psudophakia in 124 (40%) eyes, high myopia in 74 (24%) eyes and giant retinal tear in 14 (5%) eyes. The retina was reattached with one procedure in 296 (95%) eyes. Final retinal reattachment was achieved in 310 (99%) eyes. The BCVA at baseline was >20/40 in 76 (24%) eyes, 20/50–20/100 in 48 (15%) eyes, 20/200–20/400 in 46 (15%) eyes and <20/400 in 142 (46%) eyes. At the last follow-up, the BCVA was >20/40 in 168 (54%) eyes, 20/50–20/100 in 60 (19%) eyes, 20/200–20/400 in 49 (16%) eyes and <20/400 in 35 (11%) eyes. The mean change in logMAR equivalent was −0.12 for the macula-on group and −1.13 for the macula-off group (p<0.0001).

Conclusion Small-gauge PPV without scleral-depressed vitreous base shaving can be associated with good anatomical and visual outcomes. Case selection based on the complexity of RD may not be required when considering small-gauge PPV.

  • retinal detachment
  • microincision small gauge pars plana vitrectomy
  • 23 25 and 27 gauge vitrectomy
  • scleral depression
  • vitreous shave

http://dx.doi.org/10.1136/bjophthalmol-2018-313626

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    Footnotes

    • Contributors Case recruitment: HT, NJSL. Study design: HT, NJSL, DSB, HWFJ. Data compilation: HT, NJSL. Data analysis: HT, NJSL, DSB, HWFJ. Writing the manuscript: HT, NJSL, DSB, HWFJ.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Ethics approval The study protocol was reviewed by the regional IRB (Quorum Review IRB) who concluded that approval was not required for this study. The study was in accordance with the principles outlined in the Declaration of Helsinki.

    • Provenance and peer review Not commissioned; externally peer reviewed.

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