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23-gauge vitrectomy system has benefits over 20- and 25-gauge systems

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A 23-gauge vitrectomy system used in 100 consecutive eyes of 100 patients has advantages over 20- and 25-gauge systems.

McGregor N. Lott, MD, and colleagues retrospectively examined patients who underwent elective 23-gauge pars plana vitrectomy for a variety of surgical indications. Results demonstrated postoperative visual acuity improvements in 68% of patients.

The mean preop visual acuity was 20/842 (range, 20/25 to light perception), and the mean postop final visual acuity was 20/429 (range, 20/20 to no light perception).

Mean preoperative IOP was 15 mm Hg compared with a mean 14 mm Hg postop.

The study authors reported no intraoperative complications, but one patient required a change to 20-gauge vitrectomy during silicone oil removal.

The study authors said the reusable 23-gauge system (Dutch Ophthalmic Research Company) offers advantages over the current 25-gauge system, including a higher flow rate, a higher tensile strength and fewer sutures.

Advantages over the 20-gauge system include less traumatic wounds, fewer sutures, quicker operating time and faster recovery, according to the study, published in the October issue of Retina.

In this study, 23-gauge surgery appeared to have comparable safety and efficacy to both 25- and 20-gauge surgery without any new complications. This study, as well as others published on 23-gauge vitrectomy, should help increase our confidence in this surgical method. In this study, there was about a 10% rate of hypotony, which is comparable to other 23-gauge surgery studies. With 23-gauge surgery, like 25-gauge surgery, the wound might not always be watertight after surgery, and that leads to the potential for complications such as hypotony and increased rates of endophthalmitis. Because of that, there still is some work to be done on optimizing wound construction. And that research would, hopefully, help maximize consistently achieving watertight incisions and minimizing any related complications.

– Carl Regillo, MD
OSN Retina/Vitreous Board Member