20G And23G Vitrectomy In The Treatment Of Idiopathic Macular Hole Efficacy Analysis

To assess and compare thecomplications and long-term visual and anatomical outcomes of20-and23-gauge phacovitrectomy (PVT) for idiopathic macular hole repair.A retrospective, consecutive, interventional case series of72eyes with idiopathic macular holes were managed with20-gauge PVT (n=36) or23-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 G250dyes.16%-24%intraocular gas tamponade, with two weeks of postoperative face-down positioning allowed macular holes to be closed with a very high success rate.The macular hole closure rate was97%with20-gauge PVT and100%with23-gauge PVT. Mean follow-up was24.06(±12.83) months with20-gauge PVT and17.47(±5.79) months with23-gauge PVT. Mean visual acuity improvement in LogMar was0.41(±0.32) with20-gauge PVT and0.52(±0.25) with23-gauge PVT (P=0.135).The incidence of retinal breaks was higher with the20-gauge PVT compared with the23-gauge PVT, occurring in5(13.9%) and0cases.There were no cases of retinal detachment. Postoperative intraocular pressure (IOP), at day1, was significantly higher with20-gaugePVT at24.77(±12.68) mmHg compared with17.20(±6.95) mmHg in23-gauge PVT(P=0.0028). at day7, was significantly higher with20-gaugePVT at20.97(±8.16) mmHg compared with17.58(±5.59) mmHg(P=0.052). in23-gauge PVT Operating times were longer in20-gauge PVT at89.36(±15.26) min compared with the23-gauge PVT at79.33(±23.82) min (P=0.04).The20-gauge PVT compared with23-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 the23-gauge PVT has advantages with regard to safety profile and operating time.