Comparative Study Of 23-Gauge Vitrectiomy Versus 20-Gauge Vitrectomy For The Treatment Of Giant Retinal Tear

Objective:To observe clinical efficacy of 23-gauge pars plana vitrectomy(PPV)withendolaserphotocoagulationand20-gaugePPVwith endolaser photocoagulation associate with scleral condensation for the management of giant retinal tear(GRT).Methods:Clinical records of 32 patients(32 eyes)with GRT enrolled in the First affiliated hospital of guangxi medical university eye ward from June 2010to May 2016 underwent 20-gauge vitrectomy system(14 patients 14 eyes)or23-gauge vitrectomy system(18 patients 18 eyes)were reviewd.All patients had complete PPV,fluid-gas exchange,silicon oil tamponade.The minimum follow-up of 1 months.The total operation time,intraocular pressure(IOP),best corrected visual acuity(BCVA),anterior segment reaction,lensectomy or lens-sparing,retinal reattachment and postoperative complications were analyzed.Results:Early postoperative anatomical reduction rate:There were no significant difference for Early postoperative anatomical reduction rate(P>0.05).BCVA:BCVA increased significantly(P<0.01)in both 20G group and 23G group the 1 months while no significant intergroup difference postoperatively(P>0.05).Intraocular pressure(IOP):There were 3 cases in 20G group and 7cases in 23G group with IOP>21mmHg but less than 30mmHg on the postoperative 1~stt day.No significant intergroup difference between preoperative and postoperative during postoperative review(P>0.05).The total operation time was 124.53±27.43min(20G group)versus 119.26±18.81min(23G group),(t=0.61 P=0.54).Postoperative anterior segment reaction:There is significant intergroup difference between 20G and 23G group of conjunctival congestion and edema on the postoperative 1 day and 1 week(P<0.05).The same to anterior chamber flare on the postoperative 1 day(P<0.05).Lens management:There were no significant difference for lensectomy or lens-sparing(P>0.05).Intraoperative complication:4 patients of 23G group were found scleral cannula slipping during surgery;8 patients of 20G group and 1 patient of 23G group were found vitreous incarcerated during surgery(P=0.004).Conclusion:Giant retinal tear(GRT)can be effective treated by 23-gauge transconjunctival vitrectomy with endolaser photocoagulation which is assisted by retinoscope and sclerotic external prop without scleral condensation.23Gtransconjunctivalvitrectomyhascharacteristicsof smallersclerotomy sites which was protect by scleral cannula,less ocular trauma,lighter inflammatory reaction of anterior.Therefore,23-gauge transconjunctivalvitrectomywithperfluorocarbonliquids,endolaser photocoagulation,filling silicone oil is a feasible surgical method for GRT.