Primary vitrectomy for rhegmatogenous retinal detachment in pseudophakic eyes: 20-gauge versus 25-gauge vitrectomy.
OBJECTIVE
To report anatomical and functional outcome of 20-gauge versus 25-gauge primary pars plana vitrectomy for management of complex rhegmatogenous retinal detachment in pseudophakic eyes.


METHODS
Prospective single-centre randomized comparative pilot trial. Fifty patients with retinal detachment (RD) not complicated by proliferative vitreoretinopathy grade B or C, who cannot be treated with a single meridional sponge, were randomized (1:1) from November 2006 to January 2010 to either 20-gauge or 25-gauge vitrectomy as first surgical intervention and followed up over a 12-month period, evaluating change in best-corrected visual acuity, anatomical success and intraocular pressure dysregulation.


RESULTS
Mean visual acuity improved by 0.88 (SD 0.67) from 1.22 logMAR (SD 0.63) to 0.34 logMAR (SD 0.31) in the 20-gauge group and by 0.53 (SD 0.91) from 0.86 logMAR (SD 0.73) to 0.34 logMAR (SD 0.46) in the 25-gauge group. Final anatomical success rate was 100% and primary success rate was 69% at 6 months of follow-up. In the 20-gauge group, the retina was attached after one single procedure in 18 eyes (72%) and in 21 eyes (84%) of the 25-gauge group. Two patients in the 25-gauge group had hypotony at the first postoperative day which normalized within 6 weeks.


CONCLUSIONS
In our series, transconjunctival sutureless 25-gauge and 20-gauge vitrectomy showed comparable results in pseudophakic RD not suitable for single sponge surgery with respect to visual outcome and retinal reattachment. Postoperative hypotony does not seem to be a significant problem of transconjunctival sutureless vitrectomy.
Center for Ophthalmology, Eberhard Karls University Tuebingen, Tuebingen, Germany.
Daniela
D
Süsskind
Center for Ophthalmology, Eberhard Karls University Tuebingen, Tuebingen, Germany.|Private Practice, Munich, Germany.
Irmingard
I
Neuhann
Department of Medical Statistics, RWTH Aachen University, Aachen, Germany.
Ralf-Dieter
RD
Hilgers
Center for Ophthalmology, Eberhard Karls University Tuebingen, Tuebingen, Germany.
Ulrike
U
Hagemann
Center for Ophthalmology, Eberhard Karls University Tuebingen, Tuebingen, Germany.|Knappschafts-Eye Hospital Sulzbach, Sulzbach, Germany.
Peter
P
Szurman
Center for Ophthalmology, Eberhard Karls University Tuebingen, Tuebingen, Germany.
Karl Ulrich
KU
Bartz-Schmidt
Center for Ophthalmology, Eberhard Karls University Tuebingen, Tuebingen, Germany.|University Eye Hospital, University of Oldenburg, Oldenburg, Germany.
Sabine
S
Aisenbrey
D000368:Aged; D005260:Female; D006801:Humans; D007429:Intraocular Pressure / Q000502:physiology; D008297:Male; D008866:Microsurgery / Q000379:methods; D008875:Middle Aged; D011183:Postoperative Complications; D011446:Prospective Studies; D019591:Pseudophakia / Q000503:physiopathology / Q000601:surgery*; D012163:Retinal Detachment / Q000503:physiopathology / Q000601:surgery*; D014792:Visual Acuity / Q000502:physiology; D014821:Vitrectomy / Q000379:methods*
25-gauge vitrectomy; pars plana vitrectomy; pseudophakic; retinal detachment; transconjunctival sutureless vitrectomy