Clinical Ophthalmology Open Access Full Text Article Comparison of retinal breaks observed during 23 gauge transconjunctival vitrectomy versus conventional 20 gauge surgery for proliferative diabetic retinopathy Dovepress open access to scientific and medical research O r I g I n A L r e s e A r C h sharif A Issa Alan Connor Maged habib David hW steel Department of Ophthalmology, sunderland eye Infirmary, sunderland, UK Correspondence: sharif A Issa Department of Ophthalmology, Sunderland Eye Infirmary, Queen Alexandra road, sunderland, sr2 9hP, UK Tel +44 191 273 6878 Fax +44 191 514 0220 email sharifissa@yahoo.co.uk submit your manuscript | www.dovepress.com Dovepress DOI: 10.2147/OPTH.S16414 Background: To assess the rate and type of retinal break formation in patients undergoing 23 gauge transconjunctival vitrectomy surgery for complications of proliferative diabetic retinopathy compared with 20 gauge vitrectomy surgery. Methods: Retrospective case notes review of two consecutive series of patients who had primary pars plana vitrectomy for complications of proliferative diabetic retinopathy by a single surgeon. The control group had standard 20 gauge vitrectomy surgery whilst the second group had 23 gauge transconjunctival vitrectomy surgery. Results: Eighty-five eyes were included in the 20 gauge group and 85 eyes in the 23 gauge group. The groups were well matched for surgical complexity and indications for surgery, as well as a variety of other preoperative variables. There was a significant reduction in the incidence of peripheral sclerotomy-related retinal breaks and lesions suspicious for breaks (4/85 [5%] 23 gauge versus 14/85 [16%] 20 gauge, P = 0.02) and posterior retinal breaks (3/85 [4%] 23 gauge versus 12/85 [14%] 20 gauge, P = 0.03). Six eyes (7%) in total had definite new retinal breaks of any type detected in the 23 gauge group compared with 16 (18.8%) in the 20 gauge group (P = 0.04). One patient in each group experienced a retinal detachment postoperatively related in both cases to a posterior retinal break associated with recurrent traction. Conclusion: In this series of patients, 23 gauge transconjunctival vitrectomy surgery was associated with a lower rate of retinal break formation than 20 gauge vitrectomy for proliferative diabetic retinopathy. Keywords: proliferative, diabetic retinopathy, transconjunctival, vitrectomy Introduction Vitrectomy is a proven and effective treatment for the complications of proliferative diabetic retinopathy (PDR). However, rhegmatogenous retinal detachment after vitrectomy for PDR secondary to iatrogenic retinal breaks remains a serious problem, with reported rates ranging from 3% to 18%.1,2 Iatrogenic breaks have been shown to be commoner after vitrectomy for PDR compared with other indications3 and related strongly to the complexity of the case, with rates ranging from 12% for cases with simple vitreous hemorrhage to 78% with complex fibrovascular proliferations.4 Breaks observed can be divided into two groups, ie, posterior breaks related to the dissection of vitreoretinal adhesions, and peripheral breaks which can in turn be subdivided into those related to the sclerotomy sites and those away from the entry sites and related to separation of the vitreous from the retinal surface. Clinical Ophthalmology 2011:5 109–114 © 2011 Issa et al, publisher and licensee Dove Medical Press Ltd.This is an Open Access article which permits unrestricted noncommercial use, provided the original work is properly cited. 109