A comparison of 23-gauge and 20-gauge vitrectomy for proliferative sickle cell retinopathy - clinical outcomes and surgical management

Aims To report anatomical and functional outcomes in patients with proliferative sickle retinopathy (PSR) who underwent 23-gauge (23G) and 20-gauge (20G) vitrectomy. Methods Retrospective consecutive case series of patients who underwent vitreoretinal intervention for complications of PSR between April 2009 and February 2015. Operations were performed at a tertiary referral centre, Moorfields Eye Hospital. Visual acuity and anatomical success rates were evaluated for PSR complicated by retinal detachment, tractional vitreous haemorrhage and macular hole. Proliferative diabetic retinopathy cases were excluded. Results A total of 71 eyes (63 patients) underwent vitreoretinal surgery for PSR complications with 26 months mean follow-up. Primary indications were: tractional retinal detachment (TRD, n = 17), TRD with rhegmatogenous retinal detachment (n = 16), rhegmatogenous retinal detachment (n = 5, macula-on: 1, macula-off: 4), vitreous haemorrhage (n = 19), epiretinal membrane (n = 6), and full thickness macula hole (n = 8). Thirty-nine cases underwent 20G vitrectomy, and 23G surgery was performed in 32 eyes. Mean best corrected visual acuity (BCVA) improved from pre-operative 1.30 LogMAR to final BCVA of 0.74 LogMAR (p < 0.01, paired t-test). 23G vitrectomy yielded slightly better 32 vs. 25 ETDRS-letter improvement compared with 20G vitrectomy (p = 0.60, NS, unpaired t-test). 23G was associated with fewer per-operative complications (23G, 18% vs. 20G, 13%). The subset of 38 eyes with retinal detachment demonstrated 79% primary reattachment rate, and a smaller BCVA improvement of 3 lines (p = 0.07, paired t-test). Conclusions Surgical intervention for complicated PSR can preserve and/or improve vision although the degree of visual acuity stabilisation remains guarded in tractional/rhegmatogenous detachments. 23G vitrectomy may give a better functional outcome with lower per-operative complication rates.