Comparison of 27-gauge versus 25-gauge vitrectomy results in patients with epiretinal membrane: 6-month follow-up

Abstract

Purpose To compare the 27G versus 25G vitrectomy in patients with epiretinal membrane (ERM). Patients and methods Sixty pseudophakic eyes of 60 consecutive patients treated by pars plana vitrectomy (PPV) using 27G (30 eyes) or 25G (30 eyes) were prospectively evaluated including eye's inflammation, surgery time, ERM ? ILM removal time and complications. Additionally, 1, 3, 7, 14, 30, 90 and 180 days after PPV, the following were estimated: intraocular pressure (IOP), sclerotomy wound closure time, distance best corrected visual acuity (DBCVA), foveal macular thickness (FMT) and surgically induced astigmatism (SIA). Results The eye's inflammation resolved within 30 days after surgery in both groups. The surgery and ERM ? ILM times were longer in the 27G group (p B 0.02). The most common postoperative complication was hypotony in both groups, more common in 25G group (23.3% vs. 10% of eyes). In 27G group, the mean IOP prior to 180 days postoperatively was higher (p \ 0.05) and the sclerotomy wound closure time was shorter (p \ 0.001). Mean DBCVA values (7, 14, 30 days after surgery) were significantly better in 27G group (p \ 0.001). The mean FMT values were similarly and significantly reduced in both groups 1 day postoperatively (p \ 0.05) as compared to preoperative values and then stabilized during follow-up. Mean SIA was lower in 27G group 30, 90 and 180 days after surgery (p \ 0.001). Conclusion The use of 27G PPV in patients with ERM significantly reduced sclerotomy wound closure time and surgically induced astigmatism, better stabilized intraocular pressure and allowed to achieve faster visual acuity improvement, as compared to 25G PPV. Keywords Epiretinal membrane Á 27-gauge Á 25-gauge Á Pars plana vitrectomy Á Visual acuity Á Surgery time Á Self-sealing sclerotomy time Á Intraocular pressure Á Complications

25 vs. 27-gauge micro-incision vitrectomy surgery for visually significant macular membranes and full-thickness macular holes: a retrospective study

“…The significantly shorter mean surgical time demonstrated with 27G instrumentation for both ERM and FTMH is encouraging and could be partially attributed to the greater functionality associated with the 27G system versus the 25G system or the surgeon's greater ease at achieving wound closure after trocar removal with a smaller gauge. However, this does appear to contradict other studies that have generally demonstrated a small increase in surgical time with the 27G system [4,19,22].…”

“…Micro-Incision Vitrectomy Surgery (MIVS) offers an excellent safety profile for patients, while the newest 27-gauge (27G) systems have potential additional safety and outcome benefits when compared to earlier MIVS platforms. This innovation towards progressively smaller instrumentation is playing a major role in the evolution of posterior segment surgery by allowing for decreased incision size and, possibly, less pain, [1,2] fewer post-surgical wound leaks and subsequently, faster recovery times [3][4][5] with a low risk of other post-operative complications (6)(7)(8). Specifically, multiple large cohort studies and a 2013 literature review concluded there was no increased risk of endophthalmitis when comparing MIVS to 20-gauge (20G) vitrectomy [9][10][11][12].…”

Comparison of 27-Gauge and 25-Gauge Microincision Vitrectomy Surgery for the Treatment of Vitreoretinal Disease: A Systematic Review and Meta-Analysis

“…Significant heterogeneity was found ( I 2 = 92%), so random effects were used. The study of Lubinski et al [ 24 ] was the main contributor of heterogeneity, and after reevaluating this study, we found nothing wrong ( Figure 4 ).…”

“…Seven studies [ 15 , 21 – 24 , 26 , 31 ] were designed as prospective randomized/nonrandomized comparative study and four studies [ 17 , 25 , 29 , 30 ] were retrospective randomized/nonrandomized comparative study. Five trials [ 15 , 17 , 21 , 24 , 29 ] enrolled 554 eyes which were conducted on ERM and six studies [ 22 , 23 , 25 , 26 , 30 , 31 ] enrolled 386 eyes which were conducted on RRD. In total, 940 eyes were included in this meta-analysis; 439 eyes were assigned to the 27-G vitrectomy group and 501 eyes to the 25-G group.…”

“…However, some studies concluded that 27-G vitrectomy requires longer operation time for the treatment of RRD cases because of the lower flow rate. Moreover, 27-G vitrectomy induced more postoperative inflammation because of sutureless wounds [ 20 , 24 – 26 ].…”