title: 20-gauge and 23-gauge phacovitrectomy for idiopathic macular holes: comparison of complications and long-term outcomes.
abstract: OBJECTIVE
  To assess and compare the complications and long-term visual and anatomical outcomes of 20- and 23-gauge phacovitrectomy (PVT) for idiopathic macular hole repair.
  
  
  METHODS
  A retrospective, consecutive, interventional case series of 72 eyes with idiopathic macular holes were managed with 20-gauge PVT (n=36) or 23-gauge PVT (n=36). All patients underwent a posterior-chamber intra-ocular lens implantation and internal-limiting-membrane peel with the aid of either trypan blue or brilliant blue G(250) dyes.
  
  
  RESULTS
  The macular hole closure rate was 97% with 20-gauge PVT and 100% with 23-gauge PVT. Mean follow-up was 24.06 (±12.83) months with 20-gauge PVT and 17.47 (±5.79) with 23-gauge PVT. Mean visual acuity improvement in LogMar was 0.41 (±0.32) with 20-gauge PVT and 0.52 (±0.25) with 23-gauge PVT (P=0.135). The incidence of retinal breaks was higher with the 20-gauge PVT compared with the 23-gauge PVT, occurring in 13 (36.1%) and 4 (11.1%) cases, respectively (P=0.025). There were no cases of retinal detachment. Postoperative intraocular pressure (IOP), at day 1, was significantly higher with 20-gauge PVT at 24.77 (±12.68) mm Hg compared with 17.20 (±6.95) mm Hg in 23-gauge PVT (P=0.0028). Operating times were longer in 20-gauge PVT at 89.36 (±15.26) min compared with the 23-gauge PVT at 79.33 (±23.82) min (P=0.04).
  
  
  CONCLUSIONS
  The 20-gauge PVT compared with 23-gauge PVT for macular hole repair is a slightly longer procedure and was associated with an increased incidence of retinal breaks and short-term elevated IOP. Both techniques have comparable visual and anatomical outcomes, but the 23-gauge PVT has advantages with regard to safety profile and operating time.
authors.affiliation: Department of Ophthalmology, Queen Alexandra Hospital, Portsmouth, UK. radhikrishnan2004@yahoo.co.uk
authors.forename: R
authors.initials: R
authors.lastname: Krishnan
authors.forename: C
authors.initials: C
authors.lastname: Tossounis
authors.forename: Y
authors.initials: Y
authors.lastname: Fung Yang
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D007429:Intraocular Pressure; D008266:Macula Lutea / Q000601:surgery; D008297:Male; D018918:Phacoemulsification / Q000009:adverse effects / Q000379:methods*; D012167:Retinal Perforations / Q000601:surgery*; D012189:Retrospective Studies; D014792:Visual Acuity; D014821:Vitrectomy / Q000009:adverse effects / Q000379:methods*