BackgroundThis study compared the postoperative outcomes of 27-gauge (G) and 25-G vitrectomy performed for the treatment of idiopathic epiretinal membrane (ERM).MethodsThe study design was single center, retrospective, interventional case series. Two hundred consecutive eyes that underwent primary vitrectomy for ERM (27-G vitrectomy in 100 eyes and 25-G vitrectomy in 100 eyes) were studied for 6 months. In all eyes, scleral tunnels were made using angle incisions, and air or gas exchange was performed.ResultsThere were no significant differences in age, spherical diopter power, as well as preoperative Early Treatment Diabetic Retinopathy Study (ETDRS) score, central retinal thickness (CRT), and intraocular pressure between the 27-G and 25-G groups. The proportions of simultaneous cataract surgery (27-G vs. 25-G: 82% vs. 90%), air-filled eyes (99% vs. 98%), and scleral wound suture at the end of surgery (0% vs. 0%) were not significantly different between two groups. The mean operation time for vitrectomy was significantly (P = 0.0322) longer by 4 min for 27-G (37 min) compared to 25-G (33 min) vitrectomy. Gain in ETDRS score was significantly (P = 0.0421) better in 27-G group (4.7 ± 8.1 letters) compared to 25-G group (1.1 ± 13.6 letters) at 1 month post-vitrectomy, but not significantly different at 3 and 6 months (P = 0.0835 and 0.0569, respectively). Decrease in CRT was significantly (P = 0.0354) greater in 27-G group (−24.2 ± 50.0 μm) compared to 25-G group (−8.0 ± 48.6 μm) at 1 month post-vitrectomy, but not significantly different at 3 and 6 months (P = 0.6059 and 0.1725, respectively). On postoperative day 1, hypotony (≤ 6 mmHg) was observed in 2 eyes in 27-G group and 6 eyes in 25-G group, while ocular hypertension (≥ 25 mmHg) was found in 4 eyes in 27-G group and 11 eyes in 25-G group, with no significant differences between two groups. Postoperative complications requiring treatment occurred in one eye (vitreous hemorrhage) in 27-G group, and in two eyes (vitreous hemorrhage and retinal detachment in one eye each) in 25-G group.ConclusionsAlthough 27-G vitrectomy requires operation time of 4 min longer compared to 25-G vitrectomy for ERM surgery, using the 27-G system results in earlier recovery of visual acuity, CRT improvement and stabilized ocular pressure.

27-G vitrectomy requires longer operative time than 25-G, but using the 27-G system results in earlier visual improvement and stabilized ocular pressure.

Purpose To report two cases of epithelial ingrowth after small incision lenticule extraction (SMILE) successfully treated without lifting the corneal cap. Observations A 34-year-old woman and a 37-year-old man who both had undergone bilateral SMILE procedures earlier at another institution, developed visually significant epithelial ingrowth into the interface pocket with an incisional tear. In both patients, the interface pocket was meticulously irrigated with a balanced salt solution to facilitate separation of the epithelial ingrowth from the interface. After that, the epithelial ingrowth was manually scraped using a blunt spatula, and removed from the pocket using 27-gauge vitreous forceps. 10–0 nylon sutures and soft bandage contact lenses were placed for 1 week. The best spectacle-corrected visual acuity improved to 20/16 or more 1-month postoperatively. No significant complications occurred. Conclusions and importance SMILE with incisional tear may cause epithelial ingrowth, resulting in significant visual disturbance. This can be successfully treated with meticulous surgical debridement of the corneal epithelium, even without lifting the corneal cap.

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