25-gauge vs 20-gauge system for pars plana vitrectomy: a prospective randomised clinical trial

Abstract

Aim: To compare 25-gauge vs 20-gauge system for pars plana vitrectomy in a prospective, randomised, controlled clinical trial. Methods: Three-port pars plana vitrectomy was performed in 60 patients belonging to 2 groups. Evaluations were performed preoperatively, intraoperatively, during the first three postoperative days, at 1 week, and at 1 and 3 months. The main outcome measure was time for surgery, divided into duration of wound opening, vitrectomy, retinal manipulation and wound closure. Results: The total duration of surgery showed no significant difference between the groups (p = 0.67). The 25-gauge group showed significantly shorter duration of wound opening (p,0.001) and wound closure (p,0.001). In contrast, the vitrectomy duration was significantly longer in the 25-gauge group (p,0.001). Conjunctival injection and subjective postoperative pain showed significantly lower irritation in the 25-gauge group (p,0.001 for both). Conclusion:The 25-gauge vitrectomy system offered significantly improved patient comfort during the first postoperative week. The smaller surgical openings facilitated wound healing and minimised pain. Duration of surgery was comparable between the two systems-the shorter time needed for wound opening and closure in the 25-gauge group being equalised by the longer vitrectomy duration. Intraoperative as well as retinal manipulation and illumination caused more surgical difficulties using the 25-gauge system.T hree-port 20-gauge vitrectomy systems have been the gold standard for vitreous surgery since 1974. 1 During the past 30 years, its instrumentation has successfully been developed further. The standard system, demanding conjunctival incisions and sclerotomies of 0.89 mm diameter (20 gauge), was subsequently made smaller and less traumatic. For example, a 23-gauge system was developed in the 1980s by Peyman 2 , and 23-gauge-sized instruments have been mainly used for paediatric ophthalmic surgery.In 2002, a 25-gauge system was developed and made commercially available by Fujii et al. 3 First reports have emphasised several advantages in the use of the new sutureless transconjunctival system. [4][5][6] One advantage was a gain in time for surgery by avoiding extra efforts to open and close sclera and conjunctiva separately. This subsequently minimises surgically induced trauma and foreign body perception otherwise caused by manipulation and sutures, as well as the possible reactions related to the suture material itself. This was supposed to reduce the duration of the convalescence period and of the postoperative inflammatory response. The microcannulas of the system permit interchangeability of instruments between entry sites and might protect the vitreous base from mechanical traction.On the other hand, suction and flow rates in the 25-gauge system are significantly lower than the comparable parameters in the established 20-gauge technique, as a result of the smaller diameter of the 25-gauge system. 7 This could eventually cause difficulties in removing tight vitreous strands, epir...

Comparison of 25- and 23-gauge sutureless microincision vitrectomy surgery in the treatment of various vitreoretinal diseases

“…[3][4][5][6][7][8][9][10][11][12] Furthermore, a few recent reports continue to prove the superiority of MIVS in direct comparison with conventional 20-gauge vitrectomy. 6,7,[14][15][16][17] Although the makers of each of two commercially available small gauges, 25 and 23 gauges, claim to offer the safest and best product, no studies have yet compared the 25-and 23-guage systems.…”

“…Although a few studies have compared these minimally invasive MIVS approaches with conventional 20-gauge vitrectomy, 6,7,[14][15][16][17] no comparison between 25-and 23-gauge MIVS has yet been reported.…”

“…MIVS shortens operative time and facilitates postoperative recovery. [4][5][6][7][8][9][10][11][12] This 25-gauge sutureless system, however, was useful only in cases of relatively simple vitreoretinal pathology owing to limitations in cutter performance and a lack of necessary accessory instruments. In 2005, Eckardt developed 23-gauge sutureless vitrectomy using an obliquely entering trocar cannular system.…”

25th RCOphth Congress, President's Session paper: 25 years of progress in vitreoretinal surgery

“…The smaller bore resulted in reduced fluid flow, which meant that any time saved in opening and closing the conjunctiva was potentially lost because of the extended vitrectomy time. 29 In addition, blockage of the cutter with fibrous tissue and breakage of the narrow instruments had been reported. 30 There were also reports of new complications.…”

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

“…However, there was no difference in total surgical time due to prolonged vitrectomy time for 25 gauge. 18 Some surgeons believe that the diminished flow of the 25-gauge probe is an advantage that provides more stable fluidics and minimizes cutter-induced motion of detached retina, which facilitates safer peripheral vitrectomy. 7 The smaller probe size and decreased flow may also allow more precise dissection of preretinal proliferative tissue compared to 20-gauge cutters.…”