[Retrospective comparison of 25-gauge vitrectomy with 20-gauge vitrectomy in the repair of retinal detachment complicated with proliferative vitreoretinopathy].

PURPOSE

To compare the surgical outcomes of 25-gauge vitrectomy with that of 20-gauge vitrectomy for the repair of retinal detachment complicated with proliferative vitreoretinopathy (PVR).

METHODS

Forty-one eyes of 40 patients (17 women, 23 men), who underwent vitrectomy for grade C PVR and had at least 6 months of follow-up period, were investigated retrospectively. The mean age of the patients was 44.6 years (range; 13-78 years). Twenty eyes underwent vitrectomy with a 25-gauge system (25 G Group, including 5 cases with hybrid surgery, i.e., vitrectomy conducted mostly with a 25-gauge and partially with 20-gauge instruments) and 21 eyes had vitrectomy with a 20-gauge system(20 G Group). The intraoperative technique used for vitreous surgery, the number of vitrectomy procedures, the length of the surgery, the surgical success rate, the best-corrected visual acuity (BCVA) and intraocular pressure (IOP) both before and after the vitrectomy were compared between the two groups.

RESULTS

There was no significant difference in preoperative background between the two groups. The number patients with inner limiting membrane peeling was significantly higher in the 25 G Group than in the 20 G Group (p = 0.020). There were no significant differences in the number of vitrectomies, surgical time and the rate of retinal reattachment between the two groups (25 G Group; 95.0%, 20 G Group; 85.7%). The BCVAs 6 months after the surgery were significantly better than preoperative BCVAs in both 25 G (p < 0.001) and 20 G Group (p = 0.003). In the 25 G Group, the BCVA was significantly improved 1, 3, and 6 month(s) after the surgery compared to before surgery (p < 0.05), while, in the 20 G Group, the BCVA was significantly improved 3 and 6 months after the surgery (p < 0.05). In addition, the BCVA 6 months after the surgery was significantly (p = 0.010) better in the 25 G Group than in the 20 G Group. There was no significant difference in either the pre- or the postoperative IOP between the two groups, while the rate of the cases with hypotony of less than 5 mmHg was significantly higher (p = 0.048) in the 20 G Group than in the 25 G Group.

CONCLUSIONS

These results suggest that, although vitrectomy only with 25-gauge system proved insufficient, 25-gauge vitrectomy may achieve the surgical outcomes for the repair of retinal detachment complicated with PVR equal to or higher than 20-gauge vitrectomy.