25-, 23-, or 20-gauge instrumentation for vitreous surgery?

Abstract

Purpose To discuss the evolution and current status of 25-, 23-, and 20-gauge vitrectomy instrumentation. Methods Literature review. Results There are multiple small case series describing the surgical techniques, clinical outcomes, and complications associated with 25-and 23-gauge vitrectomy. These studies suggest that small-gauge vitrectomy may shorten operating time, improve patient comfort, and speed visual recovery. However, increased complication rates involving hypotony and endophthalmitis have been reported. There are no level 1 evidence-based studies comparing the efficacy and safety of 25-, 23-, and 20-gauge vitrectomy. Conclusion 25-and 23-gauge vitrectomy techniques may shorten operating time, improve patient comfort, and speed visual recovery. However, larger and better designed evidence-based studies are required to better understand relative values of 25-, 23-, and 20-gauge vitrectomy.

Comparison of postoperative intraocular pressure changes between 23-gauge transconjunctival sutureless vitrectomy and conventional 20-gauge vitrectomy

“…Twenty-fivegauge TSV was introduced by Fujii et al 1 and despite numerous beneficial features, it confers several disadvantages such as limited surgical instrument usage, a flexible cutter which sets limits on surgical approaches to the peripheral retina and vitreous, and a longer time for vitreous removal. 2,3 Subsequently, 23-gauge TSV was introduced by Eckardt et al 4 to combine the beneficial features of both the 20-and 25-gauge vitrectomy systems. 3 As it has only recently been developed, studies on the efficacy and safety of 23-gauge TSV have been limited, [5][6][7][8][9][10][11] and few comprehensive comparisons with conventional 20-gauge vitrectomy for limited indications of vitrectomy have been performed.…”

“…2,3 Subsequently, 23-gauge TSV was introduced by Eckardt et al 4 to combine the beneficial features of both the 20-and 25-gauge vitrectomy systems. 3 As it has only recently been developed, studies on the efficacy and safety of 23-gauge TSV have been limited, [5][6][7][8][9][10][11] and few comprehensive comparisons with conventional 20-gauge vitrectomy for limited indications of vitrectomy have been performed. 12,13 Specifically, in regard to postoperative hypotony or hypertony, although those are the major complications of vitrectomy, there have been few comparative studies with inconclusive number of patients.…”

Innovative Technologies in Pars Plana Vitrectomy - Minimally Invasive Vitrectomy System

“…If the transorifice pressure is too low, the removal of the vitreous will be too long and if the transorifice pressure is too high, traction will be generated at the vitreo-retinal interface [1,5,6].…”

“…The development of new instruments capable to overcome the size and lumen handicaps became necessary [1,5,6].…”

Surgically induced astigmatism after 23-gauge transconjunctival sutureless vitrectomy

“…[1][2][3][4][5][6][7][8] By eliminating the need for scleral cautery or suture, TSV might reduce postoperative surgically induced astigmatism (SIA). There have been a few studies looking at astigmatic changes after TSV.…”