Outcomes of 140 consecutive cases of 25-gauge transconjunctival surgery for posterior segment disease.
OBJECTIVE
To evaluate the safety and efficacy of 25-gauge instrumentation for a variety of vitreoretinal conditions on previously nonvitrectomized eyes.


METHODS
Single-center, retrospective, interventional case series.


METHODS
One-hundred forty eyes of 140 patients were evaluated at the Doheny Retina Institute from July 2002 to July 2003.


METHODS
All patients underwent surgical procedures using the Millennium 25-gauge Transconjunctival Standard Vitrectomy system. Twenty eyes (14.3%) underwent procedures without vitrectomy.


METHODS
Postoperative visual acuity (VA), intraocular pressure, surgical time, postoperative inflammation, complications, and number of sutured sites.


RESULTS
No intraoperative complications were noted. No cases required conversion to 20-gauge machines. Ten cases (7.1%) involved single-site sclerotomy suture placement due to bleb formation at the conclusion of the procedure, but 5 of these entry sites were enlarged to facilitate larger instrumentation for tissue manipulation. Median VA improved from 20/250 (logarithm of the minimum angle of resolution, 1.08+/-0.47) preoperatively to 20/60 (0.47+/-0.30) (P<0.0001) at final visit. Mean follow-up was 33.8+/-9.7 weeks, and all eyes were observed for a minimum of 12 weeks. Mean total surgical time was 17.4+/-6.9 minutes. Intraocular pressures remained stable throughout the postoperative course. Five eyes (3.8%) presented on day 1 with shallow choroidal detachments, but all resolved by day 7, and none required volume infusion during the postoperative period. All but one of these cases was within the first 50 procedures performed. No detectable inflammation was noted in any eyes by 4 weeks postoperatively. No case of retinal detachment or endophthalmitis was recorded.


CONCLUSIONS
Transconjunctival surgery using 25-gauge instrumentation may hasten postoperative recovery by decreasing overall surgical time and postoperative inflammation. Procedures requiring minimal intraocular manipulation did not require sutures and, thus, may be better suited for this surgical modality.
Lakhanpal
Rohit R
RR
Doheny Retina Institute, Doheny Eye Institute, Department of Ophthalmology, Keck School of Medicine, University of Southern California, Los Angeles, California 90033, USA.
Humayun
Mark S
MS
de Juan
Eugene
E
Lim
Jennifer I
JI
Chong
Lawrence P
LP
Chang
Tom S
TS
Javaheri
Michael
M
Fujii
Gildo Y
GY
Barnes
Aaron C
AC
Alexandrou
Terry J
TJ
D000368:Aged; D003228:Conjunctiva / Q000601:surgery; D005128:Eye Diseases / Q000601:surgery*; D005260:Female; D006801:Humans; D007429:Intraocular Pressure; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D012164:Retinal Diseases / Q000601:surgery*; D012189:Retrospective Studies; D012449:Safety; D016896:Treatment Outcome; D014792:Visual Acuity; D014821:Vitrectomy / Q000295:instrumentation* / Q000379:methods; D014822:Vitreous Body / Q000601:surgery*