Long-Term Visual Outcomes and Safety Profile of 27-Gauge Pars Plana Vitrectomy for Posterior Segment Disease

Abstract

Purpose: To report longer-term outcomes of 27-gauge pars plana vitrectomy (PPV) in eyes with posterior segment disease.

Design: Multicenter, retrospective, interventional case series.

Participants: A total of 390 eyes of 360 patients undergoing 27-gauge PPV for a vitreoretinal surgery indication.

Intervention: Three-port, transconjunctival, 27-gauge PPV.

Main outcome measures: Change in visual acuity (VA) and occurrence of intraoperative and postoperative complications with a minimum follow-up of 365 days.

Results: Mean follow-up was 715±332 days (median, 514; range, 365-1440 days). Surgical indications included epiretinal membrane (ERM) (n = 121), vitreous floaters (n = 69), diabetic tractional retinal detachment (n = 49), vitreous hemorrhage (n = 40), full-thickness macular hole (n = 33), recurrent proliferative vitreoretinopathy (PVR)-related retinal detachment (n = 18), primary rhegmatogenous retinal detachment (RRD) (n = 17), silicone oil removal (n = 16), dislocated intraocular lens (n = 10), submacular hemorrhage (n = 7), endophthalmitis (n = 6), and retained lens material (n = 4). Mean logarithm of the minimum angle of resolution (logMAR) VA improved from 0.72±0.62 (20/105 Snellen equivalent) preoperatively to 0.40±0.55 (20/50 Snellen equivalent) postoperatively (P < 0.001). No case required conversion to 23- or 25-gauge instrumentation. Postoperative complications included transient ocular hypertension in 44 eyes (11.3%), vitreous hemorrhage in 31 eyes (7.9%), and transient hypotony in 22 eyes (5.6%). Acute postoperative endophthalmitis occurred in 1 case (0.26%). Overall, 82 of 390 eyes (21.0%) underwent at least 1 additional intraocular surgery in the follow-up period, most commonly for cataract extraction (n = 40/82 eyes, 48.8%). Of the 18 eyes undergoing surgery for primary RRD, recurrent detachment due to PVR occurred in 2 eyes (11.1%).

Conclusions: At a minimum follow-up of 1 year, 27-gauge PPV was well tolerated with low rates of postoperative complications across varied surgical indications, including primary and complex retinal detachment.