Comparison of outcomes between 20, 23 and 25 gauge vitrectomy for idiopathic macular hole

To compare the results of 20, 23, 25 gauge pars plana vitrectomy (PPV) with two different gas tamponades for idiopathic macular hole (MH) in a multi-surgeon vitroretinal practice.

In this comparative, retrospective, interventional case series, the medical charts of 142 eyes/130 patients were reviewed. Patients who matched our inclusion criteria: eye with stage 2, 3, or 4 MH that underwent 20, 23, or 25 gauge PPV, internal limiting membrane (ILM) peeling, and fluid-gas exchange from January, 2005 to May, 2012 and had at least 6 months follow-up. The best current corrected visual acuity (VA) and anatomical status of the MH were assessed by optical coherent tomography (OCT) at 6 months, 1 year, and 2 years after vitrectomy.

The MH closed successfully after primary vitrectomy in 86.5 % (20 gauge), 96.4 % (23 gauge), and 92 % (25 gauge). Preoperative VA median were 20\126 (20 gauge), 20\100 (23 gauge), and 20\80 (25 gauge). At 6 months and 2 years postoperative VA did not differ significantly between the 3 groups (p = 0.570, and 0.054 respectively). However, at 12 months postoperative VA median 20\60 (20 gauge), 20\69 (23 gauge), and 20\40 (25 gauge) differ significantly (p = 0.005) likely due to cataract changes. The final median postoperative VA (at 2 years) in 25 gauge PPV group was 20/40 which was better than final visual outcomes for 20, and 23 gauge PPV groups (20/50, and 20/55 respectively). The different was not a statistically significant. MH closed successfully in 96 % (C3F8), and 88.1 % (SF6) (p = 0.063). Preoperative median VA was 20/100 in both groups of gas. At 6 months, 1 year, and 2 years postoperative median VAs did not differ significant between the 2 groups (p = 0.076, 0.343, and 0.309 respectively). MH closed successfully in (96.9 %) 12-14 % C3F8, and (95.3 %) 15-16 % C3F8 (p = 0.611). MH closed in (82.1 %) 18-20 % SF6, and (96.4 %) 22-26 % SF6 (p=0.053).

Based on the results of this study, 20, 23, and 25 gauge of PPV have similar MH closure rates and VA outcomes. SF6 at 22-26 % or C3F8 at 12-14 % achieved maximum closure rates.