Further experience with 23-gauge
transconjunctival vitrectomy
Claus Eckardt (Frankfurt/M.)
Purpose: To describe our continued experience using 23-gauge vitrectomy.
Design: Retrospective study of consecutive cases.
Methods: The complications and problems as well as early postoperative results of 23-gauge
vitrectomies performed on a total of 370 eyes were investigated. The results were compared
with those of conventional 20-gauge vitrectomy.
Results: The cases represented the entire spectrum of surgically correctable vitreoretinal
disorders. Some were surgically easy to treat pathologies of the macula, other disorders such
as PVR retinal detachment and advanced diabetic retinal detachment were extremely difficult
to treat surgically. In none of the cases did we have to change to a conventional 20-gauge
technique during surgery or use a suture to close the scleral tunnel incisions at conclusion of the procedure. There were no
intraoperative complications associated with the microcannulas. Almost all surgical techniques could be performed in the
same manner as with 20-gauge instruments. Only two eyes has an intraocular pressure below 10 mmHg on the first day postoperative;
in both eyes the pressure soon returned to normal. All other eyes had consistently normal pressure. Two eyes
developed endophthalmitis. The anatomic and functional results were on the whole comparable to those in similar cases
operated on earlier using a conventional 20-gauge technique. Due to the minimal traumatization of the conjunctiva and
sclera, 23-gauge vitrectomy was found to be especially advantageous in surgically complicated cases requiring multiple
interventions.
Conclusion: Transconjunctival created scleral tunnel incisions created for microcannulas for 23-gauge instruments
guaranteed an almost 100% rapid self-sealing closure of the sclerotomies. Due to its wide range of applications, 23-gauge
vitrectomy can be used in place of conventional 20-gauge vitrectomy in most cases.