Less traumatic surgery

October 1, 2011

Rapid technology advancements have given narrow gauge surgery the edge in diabetic cases

Vitrectomy has been proven as an effective treatment for patients with proliferative diabetic retinopathy (PDR) and many surgeons are now using narrow gauge instrumentation to perform the surgery. However, previous literature has revealed some potential disadvantages to the technique and it has been questioned whether narrow gauge surgery is associated with an increased rate of peripheral retinal break formation in macular surgery and also of relevance, a lower success rate in retinal reattachment surgery than 20G surgery.1,2

Achieving the surgical aims

To examine the incidence of retinal break formation in patients being treated for PDR, Dr Steel and colleagues retrospectively reviewed a group of 170 eyes. Half of the eyes comprised the control group and underwent conventional 20G surgery and the other half were treated with 23G transconjunctival vitrectomy surgery.

"We analysed a variety of factors in the case mix to see if the groups could be compared in a meaningful way including basic demographics, for example, it is known younger patients have a higher incidence of retinal break formation during diabetic vitrectomy, as well as a variety of metabolic indicators (e.g., HbAic)," added Dr Steel. "We also looked at the surgery performed - hence analysed the proportion of combined cases and in particular and importantly the extent and position of vitreoretinal adhesion, which defines the complexity of the cases."

Dr Steel reported that while he was transitioning from using 20G to 23G surgery he continued to perform the former technique on complex cases. Therefore, he excluded patients that were operated on during that period from the study.