A comparative study of anatomical and functional outcomes after 20, 23 and 25 gauge pars plana vitrectomy in adult population at a tertiary care center in Rajasthan

Abstract

Pars plana vitrectomy is the most common technique in vitreoretinal surgery that enables access to the posterior segment for treating conditions such as retinal detachment, vitreous hemorrhage, macular hole, endophthalmitis, dropped nucleus and dropped iol in a controlled closed system.Prospective, comparative study of patients, more than 18 years of age, who underwent pars plana vitrectomy for various vitreoretinal disease at J.L.N. Medical College, Ajmer, from October 2020 to March 2022,with no previous history of any vitreoretinal surgery.96 eyes of 96 patients that underwent 20-gauge (n=32), 23-gauge (n=32) and 25-gauge (n=32) Pars plana vitrectomy were included in this study. The mean duration of surgery was significantly higher in the conventional 20-Gauge as compared to the micro incisional vitrectomy system. Mean Best corrected visual acuity (BCVA) improved significantly in all three groups at postoperative 3 months, no significant difference between the 3 groups. Re retinal detachment occurs in 6 eyes(2 eyes in each group). Recurrent vitreous hemorrhage occurs in 1 eye in 25-gauge and postoperative endophthalmitis occurs in 2 eyes(1 eye each in 20-gauge and 23-gauge). There was a similar rate of ocular hypertension in all three groups. Postoperatively 20-gauge showed significantly higher mean conjunctival hyperemia and subconjunctival hemorrhage compared to Sutureless microincisional vitrectomy surgery.Functional and anatomical outcomes assessed by BCVA and retinal status postoperatively seem to be comparable between 20,23 and 25-gauge vitrectomy systems. Sutureless microincisional vitrectomy surgery showed significantly shorter duration of surgery.