Comparision of 20 gauge standart vitrectomy and 23 gauge transconjunctival suturless vitrectomy for idiopathic macular hole and idiopathic epiretinal membrane surgery

This study was conducted between July 2007-April 2009 in Gazi University, School of Medicine, Ophthalmology Department in a prospective design. A total of 64 eyes of 61 cases with diagnosis of stage 3-4 idiopathic macular hole(IMH) or stage 1-2 idiopathic epiretinal membrane(IERM) were included in this study. 20G ve 23G pars plana vitrectomy were performed. Ocular surface inflammation was graded on a standardized scale. Postoperative discomfort and pain was assessed according to a questionnaire which was performed on the first postoperative month. Anatomical success was defined as hole closure for IMH cases and membraneless period of 3 months postoperatively for IERM cases and these were confirmed by OCT.There were 31 eyes of 30 cases in 20G group and the distribution of cases was 12 IMH(%38,7) and 19 IERM(%61,3); in 23G group there were 33 eyes of 31 cases of 11 IMH(%33,3) and 22 IERM(%66,6). The mean age was 60,0±10,5 years in 20G group and 60,0±10,5 years in 23G group. The mean follow-up time was 12,8±7,9 months and 11,5±4,1 months for 20G and 23G groups respectively. No significant differences were found between 2 groups for the baseline values. Macular hole closure rate after first surgery was %83 and %90,9 in 20G and 23G groups respectively and there was no significant difference between groups(p=0,59). Anatomical success rate for IERM cases was %100 for both groups. None of the patients in any of the groups had postoperative complications of severe postoperative hypotony, choroidal effusion, vitreous hemorrhage or endophthalmitis except only one eye in 20G group which was found to have retinal detachment. Postoperative ocular surface inflammation as well as subjective ocular discomfort and pain showed significantly lower values in 23G group compaired with 20G group. There was no statistically significant difference between overall surgical times.In conclusion, transconjunctival suturless 23G vitrectomy appears to be as effective and safe as conventional 20G vitrectomy in IMH and IERM surgeries. As an advantage 23G surgery offers improved patient comfort and less postoperative conjunctival inflammation.