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Incidence of detachment lower after 20-gauge vitrectomy

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MONTREAL — The incidence of retinal detachment was significantly lower in patients who underwent vitrectomy with a 20-gauge vitrector than in those who underwent surgery with a 25-gauge instrument in a study presented here.

David F. Williams, MD, MBA, told attendees at the American Society of Retina Specialists that a statistically significant difference was seen in the incidence of postoperative rhegmatogenous retinal detachment (RRD) after 25-gauge vitrectomy than after 20-gauge vitrectomy for epiretinal membrane or symptomatic vitreous opacities. In Dr. Williams’ study, 337 eyes underwent vitrectomy with a 20-gauge vitrector and 206 eyes with a 25-gauge vitrector. Patients enrolled in this study had undergone vitrectomy between 1995 and 2004, Dr. Williams noted.

“Two patients in the 20-gauge group developed RRD,” he said. “Nine patients in the 25-gauge group also developed RRD…. This is a sevenfold difference in significance.” The difference was statistically significant (P = .002), he said.

In addition, he said, the 25-gauge vitrectomy “was characterized by a less complete vitrectomy and by greater difficulty assessing the retinal periphery at the conclusion of the procedure.”

Patients who underwent surgery with a 25-gauge instrument presented with RRD within 30 days of surgery, he said, while in the 20-gauge group RRD presented 7 to 9 months after surgery.

The final visual acuity was similar between the two groups, Dr. Williams said. The 25-gauge instrumentation has some advantages, he said, including “less surgical disturbance of the external eye, faster visual recovery, faster healing, less need for both perioperative and postoperative medications and faster surgery.”

Disadvantages in an earlier version of the 25-gauge system used for this study included the trocar creating a “significant distortion of the globe on insertion,” Dr. Williams said. In addition, he said, “it was more difficult to work in the peripheral vitreous and on the peripheral retina, and it was more difficult to do a so-called complete vitrectomy.”