ASRS 2023: 27-Gauge vs 25-gauge vitrectomy for symptomatic vitreous opacities

Our team spoke with Shawn Kavoussi, MD, at the 2023 ASRS meeting in Seattle, Washington about his research on using infrared video for vitreous opacities and comparing postoperative reduction in vitreous opacity scores using infrared video with the Heidelberg spectralis unit.

Video Transcript

Editor's note - This transcript has been edited for clarity.

Shawn Kavoussi, MD:

Dr Shawn Kavoussi from Houston, Texas. I'm excited to be here at ASRS in Seattle. My topic was using infrared video for vitreous opacities and comparing postoperative reduction in vitreous opacity scores using infrared video with the Heidelberg spectralis unit.

Patients were routine referrals with a chief complaint of symptomatic vitreous opacities. There were 38 eyes from 32 patients. The patients had preoperative infrared video scanning to quantify the vitreous opacities. And then the infrared video was used to grade the opacities using the macular vitreous opacity score that I presented last year, grades 1 through 4, which approximate how many quadrants of the macula are obscured by the vitreous opacities.

So what I found was that the pre-op macular vitreous opacities score in patients who elected to have vitrectomy for symptomatic floaters, the vast majority of cases were grade 2, which means that 26 to 50% of the macula was obscured. There were a few patients that were grade 3 and grade 4. Grade 3 means that 51 to 75% of the macular is obscured. Grade 4 means that greater than 75% of the macula is obscured, and many of the grade 4 patients had hemorrhagic PVDs, at the pre-op visit with either suspected or confirmed horseshoe tears at the pre-op screening. Half of the patients underwent 27 gauge vitrectomy on the Alcon constellation system. The other half underwent 25 gauge vitrectomy. All of the hemorrhagic PVD cases underwent 25 gauge vitrectomy on an urgent basis with endo laser.

About 1/3 of the patients were phakic at the pre-op screening but 80% of the hemorrhagic PVD patients were phakic. Average pre-op nvos was in the low 2s for the elective cases. Pre-op nvos was about 2.5, if you include the hemorrhagic PVDs. Altogether, 26 of the 38 eyes were novs grade 2 at pre-op. Post-operatively, 95% of the patients achieved nvos grade 0, meaning no opacities on the follow-up Heidelberg infrared video. There were 2 cases of slight residual grade 1 opacity post op, 1 in the 25 gauge group and 1 of the 27 gauge group. So there was no significant difference in post-operative vitreous opacity scores.