New Combined 23-20 Gauge Vitreoretinal Surgery

Abstract Purpose:to evaluate the safety and efficacy of a combined 23-20 gauge vitreoretinal surgery technique. Methods:two groups of patients with different macular diseases were considered in this observational prospective study. All patients underwent macular surgery. In Group I transconjunctival sutureless 23 gauge vitreoretinal surgery was performed in 30 eyes. In Group II a combined 23-20 gauge vitreoretinal surgery was performed in other 30 eyes. In the combined technique of Group II two 23 gauge transconjunctival trocars for infusion cannula and endoilluminator and one 20 gauge sclerotomy for surgical instruments were carried out. 20 gauge sclerotomy was preceded by a small radial incision of the conjunctiva in the needed location and sutured at the end of surgery. Anatomical and functional parameters were evaluated before and after surgery in all 60 eyes (mean follow up 8.2 months). Results:all surgical procedures in patients of both groups have been successfully performed. The mean first day IOP was 16,4 mmHg in Group I and 17, 2 mmHg in Group II (p>0.05). Two patients in Group I and one patient in Group II had postoperative transient hypotony. Two 23 gauge scleral ports required suture in Group I at the end of surgery, only one in Group II. No 23 gauge technique required conversion to 20 gauge surgery. A recurrent postoperative intravitreal hemorrhage in group I and one postoperative rhegmatogenous retinal detachment in Group II were observed. No endophthalmitis were noted during the postoperative follow up. Conclusions:combined 23-20 gauge vitreoretinal surgery appears to be effective. Main indications to 23-20 gauge combined technique could be the lack of dedicated available instruments smaller than 20 gauge and some particular surgery procedures such as silicone oil management. In addition it could reduce the learning curve for small gauge vitreoretinal surgery.