Search

Betül Ilkay Sezgin Akçay1, Osman Murat Uyar2, Fevzi Akkan2, Kadir Eltutar21Ümraniye Training and Research Hospital, İstanbul, Turkey; 2İstanbul Training and Research Hospital, İstanbul, TurkeyPurpose: The aim of this study was to assess the efficiency and reliability of the 23-gauge (23G) transconjunctival vitrectomy system and examine possible complications of this surgical technique in a variety of vitreoretinal conditions along with early postoperative intraocular pressure (IOP) changes.Materials and methods: A total of 350 eyes of 324 patients having undergone 23G transconjunctival vitrectomy were included in this prospective study. A total of 150 (46.2%) were male and 174 (53.8%) female, with a mean age of 61.28 ± 15.67 years. Mean follow-up time was 8.3 months.Results: Mean BCVA logMARs were as follows: preoperatively 0.839 ± 0.59, postoperatively first day 2.07 ± 0.76, first week 1.14 ± 0,43, first month 0.63 ± 0.26 and last examination 0.359 ± 0.17. Mean BCVA decreased significantly (P < 0.001, P < 0.028, respectively) on postoperative first day and first week, mainly due to air or gas tamponade, and increased significantly in the first month and final control in almost all indications (P < 0.001). Postoperative mild hypotony (IOP ≤ 10 mmHg) was detected in 112 (32%) eyes on day 1 and in 59 (16.8%) eyes in week 1. While postoperative serious hypotony (≤5 mmHg) was detected in 34 (9.7%) eyes on day 1, it was not detected in any eyes at the end of the first week. None of the eyes required an additional gas tamponade or any other procedure in the early postoperative period due to hypotony. A total of 13 (3.7%) eyes were reoperated for recurrent vitreous hemorrhage; 23 (6.5%) eyes were reoperated on a second time, nine (2.5%) a third time, and 1 (0.2%) a fourth time for recurrent rhegmatogenous retinal detachment. Postoperative fibrinoid reaction was seen in 17 (4.8%) eyes on the first day and responded well to the medications. Cataract development was found in 61 (22.5%) of the 270 phakic eyes after a mean duration of 6.4 ± 3.5 months. Anatomical success was obtained in 86% of the patients and functional success in 72%.Conclusion: The 23G transconjunctival vitrectomy system is safe and effective in a wide field of vitreoretinal conditions. It is a good alternative to 20G and 25G techniques but needs some improvement mainly in regards to the instruments and related techniques; further larger controlled group studies are needed.Keywords: vitreoretinal surgery, 23G transconjunctival vitrectomy

Background: To examine the differences in intraocular pressure (IOP) measurements obtained with Goldmann applanation tonometry (GAT) and Pascal dynamic contour tonometry (DCT) in subjects with thin corneas and to correlate these with structural and functional parameters of glaucoma damage., Patients and Methods: One hundred and thirty participants (130 eyes) with central corneal thickness lower than 500 µm were included in five groups in this cross-sectional observational study: 52 eyes with primary open angle glaucoma (POAG), 19 eyes with normal tension glaucoma (NTG), 27 eyes with ocular hypertension (OHT), 21 participants suspected of having glaucoma (GS), and 11 healthy subjects. The measurements were obtained with GAT and DCT in a masked fashion. The corrected GAT-IOP for central corneal thickness (CCT), the difference between DCT and GAT (ΔIOP = DCT-GAT) and corrected ΔIOP (corrected ΔIOP = DCT-corrected GAT) were calculated. Age, mean deviation (MD) from the most recent reliable visual field examination, average retinal nerve fibre layer thickness (RNFL), cup-to-disc ratio (CDR), ocular pulse amplitude (OPA), and treatment status were recorded for statistical analysis., Results: In all of the subjects (n = 130), the mean DCT, GAT and corrected GAT values were 17.6 ± 3.4 mmHg, 13.2 ± 3.8 mmHg, and 15.5 ± 2.1 mmHg, respectively. ΔIOP and corrected ΔIOP were 4.4 ± 2 mmHg and 1.7 ± 2 mmHg, respectively. ΔIOP was correlated negatively with MD (rs = -0.32, p < 0.0001) and average RNFL thickness (r = -0.46, p < 0.0001) and positively with CDR (rs = 0.50, p < 0.0001). The mean IOP measured by GAT differed statistically significantly between eyes with glaucoma (n = 71, POAG and NTG) and eyes without damage (n = 59; OHT, GS, and healthy) (p < 0.0001), whereas the mean IOP by DCT did not (p = 0.935). The mean ΔIOP values were also statistically significantly higher in the glaucomatous group, with and without correction for CCT (p < 0.001). OPA and glaucoma diagnoses statistically significantly predicted ΔIOP (R(2) = 0.41, F2.127 = 47.46, p < 0.0001)., Conclusion: Greater underestimation of IOP by GAT was observed in the glaucomatous eyes with thin corneas. Performing DCT on patients with thin corneas might be advantageous in establishing the need for more aggressive treatment., (Georg Thieme Verlag KG Stuttgart · New York.)

Purpose: The aim of this study was to assess the efficiency and reliability of the 23-gauge (23G) transconjunctival vitrectomy system and examine possible complications of this surgical technique in a variety of vitreoretinal conditions along with early postoperative intraocular pressure (IOP) changes., Materials and Methods: A total of 350 eyes of 324 patients having undergone 23G transconjunctival vitrectomy were included in this prospective study. A total of 150 (46.2%) were male and 174 (53.8%) female, with a mean age of 61.28 ± 15.67 years. Mean follow-up time was 8.3 months., Results: Mean BCVA logMARs were as follows: preoperatively 0.839 ± 0.59, postoperatively first day 2.07 ± 0.76, first week 1.14 ± 0,43, first month 0.63 ± 0.26 and last examination 0.359 ± 0.17. Mean BCVA decreased significantly (P < 0.001, P < 0.028, respectively) on postoperative first day and first week, mainly due to air or gas tamponade, and increased significantly in the first month and final control in almost all indications (P < 0.001). Postoperative mild hypotony (IOP ≤ 10 mmHg) was detected in 112 (32%) eyes on day 1 and in 59 (16.8%) eyes in week 1. While postoperative serious hypotony (≤ 5 mmHg) was detected in 34 (9.7%) eyes on day 1, it was not detected in any eyes at the end of the first week. None of the eyes required an additional gas tamponade or any other procedure in the early postoperative period due to hypotony. A total of 13 (3.7%) eyes were reoperated for recurrent vitreous hemorrhage; 23 (6.5%) eyes were reoperated on a second time, nine (2.5%) a third time, and 1 (0.2%) a fourth time for recurrent rhegmatogenous retinal detachment. Postoperative fibrinoid reaction was seen in 17 (4.8%) eyes on the first day and responded well to the medications. Cataract development was found in 61 (22.5%) of the 270 phakic eyes after a mean duration of 6.4 ± 3.5 months. Anatomical success was obtained in 86% of the patients and functional success in 72%., Conclusion: The 23G transconjunctival vitrectomy system is safe and effective in a wide field of vitreoretinal conditions. It is a good alternative to 20G and 25G techniques but needs some improvement mainly in regards to the instruments and related techniques; further larger controlled group studies are needed.