Intraoperative Retinal Break Formation in 23-/25-Gauge Vitrectomy versus 20-Gauge Vitrectomy

Abstract

Background: This study was undertaken to examine the possible effect of microcannula-guided entry sites on the rate of intraoperative retinal break formation. Methods: In this historical cohort study, all patients having undergone vitrectomy with epiretinal or internal limiting membrane peeling performed by one surgeon between January 2005 and March 2009 were included. All procedures with microcannula-guided entry sites (23- and 25-gauge vitrectomy) were compared to procedures without the use of microcannulas (20-gauge vitrectomy). Results: A total of 221 eyes with a follow-up of at least 30 days were analyzed. The total incidence of intraoperative retinal break formation was 25.2% (n = 28/111) for the 20-gauge group and 12.7% (n = 14/110) for the 23-/25-gauge group, resulting in an odds ratio of 2.313 (95% confidence interval 1.142–4.685) of an increased rate in the 20-gauge group. Conclusion: This study demonstrates that intraoperative retinal breaks during vitrectomy are reduced in the microcannula-guided techniques compared to 20-gauge vitrectomy. This effect may be attributed to the protection of the vitreous base during surgery. Further prospective studies are warranted.

23-Gauge versus 25-Gauge Vitrectomy for Proliferative Diabetic Retinopathy: A Comparison of Surgical Outcomes

“…However, we did not find this difference comparing the 23g and 25g groups. Several papers have reported that significantly fewer peripheral retinal breaks are caused by cannulated 23g systems compared to the 20g [12,13,29]. Our entry site break rate was very low in both groups at 1 eye in each group as may have been expected since the cannulated sclerostomy system is identical in length in each gauge at 6 mm.…”

“…A reported benefit of transconjunctival small-gauge surgery over 20g is faster visual recovery [12,13]. This study did not find that this trend continues when comparing 23g to 25g.…”

“…Numerous studies have favourably compared aspects of narrow-gauge surgery to traditional sutured 20g surgery [9,10,11]. Studies have also found a reduction in peripheral retinal break formation near the sclerostomy sites with the cannulated sclerostomies used in narrow-gauge systems [12,13]. …”

Surgical outcomes of 25-gauge pars plana vitrectomy for diabetic tractional retinal detachment

“…16 Breaks may also be avoided via smaller microcannulas, as they may better preserve the vitreous base and prevent vitreal incarceration and dragging. 10 Twenty-five-gauge instrumentation also allows easier access to small areas, providing safer vitrectomy and more precise dissection of membranes. 12,16 Still, there remain documented concerns with the use of 25-G PPV for complicated surgical cases, including diabetic TRD.…”

“…These include reduced operative times, reduced postoperative inflammation, faster visual recovery, increased patient comfort, reduced rate of intraoperative retinal break formation, avoidance of conjunctival dissection and limbal stem cell damage, and less induced corneal astigmatism. [5][6][7][8][9][10][11][12] Upon its advent, 25-G PPV was applied towards treating macular holes, idiopathic epiretinal membranes, refractory macular edema, and non-clearing vitreous hemorrhage. 13 There were concerns that fragility or inadequate variety of instrumentation may limit its usefulness in more complicated surgical disease.…”