23-gauge vitrectomy ‘effective’ for sutureless surgery

RIO GRANDE, Puerto Rico — Using a 23-gauge vitrectomy system on patients with various retinal pathologies may involve a surgeon learning curve, but is “an effective alternative for sutureless vitrectomy,” said Keith A. Warren, MD.

The typical 20-gauge vitrector is about 1 mm in diameter, Dr. Warren told attendees of the Masters of the American Society of Retina Specialists meeting. The typical 25-gauge is about 0.5 mm in diameter, and the 23-gauge is somewhere in between, he said. Both the 20- and 25-gauge systems involve increased surgical times or reduced flow in some surgeries, he said.

Dr. Warren retrospectively reviewed 31 patients who underwent vitrectomy with a 23-gauge system (DORC). Of the patients, 10 were being treated for diabetic vitreous hemorrhage, seven had diabetic tractional detachment, five had primary retinal detachment, and five had macular holes. The remaining patients had macular pucker, diabetic cystoid macular edema, or branch retinal vein occlusion or hemorrhage, Dr. Warren said.

All patients were treated preoperatively with Vigamox (moxifloxacin HCl ophthalmic solution 0.5%, Alcon) and then underwent a standard three-port vitrectomy. Eleven patients had a visual acuity between 20/40 and 20/60 preop; the mean preop IOP was 18 mm Hg. Postoperative IOP dropped to 17 mm Hg, Dr. Warren noted. Patients were followed for at least 3 months.

“None of the patients had hypotony,” he said. “None of the patients had to be converted to a 20-gauge vitrectomy,” although two patients had serious complications — vitreous hemorrhage and peripheral retinal tear. Five patients had minor subconjunctival hemorrhages, and one had subconjuctival gas.

“The retinal tear was on the periphery — at 11 o’clock, away from the trocar,” he said.

“It’s an easy learning curve from 20- or 25-gauge,” Dr. Warren added. “You need prophylactic antibiotic for the endophthalmitis risk.”