Indications for 23- and 25-gauge expand with experience

NUREMBERG, Germany — Applications for 23- and 25-gauge vitrectomy are continuing to expand as surgeons gain more experience, according to one retinal surgeon speaking here.

Claus Eckardt, MD, explained that he has found 23-gauge instruments to be better suited for more complicated cases and 25-gauge instruments to be helpful in easier and simple cases.

“Small instruments are quite flexible,” Dr. Eckardt told attendees of the German Ophthalmic Surgeons meeting. “The flexibility is extremely annoying and the learning curve is tremendous.”

Complications such as instrument fractures, postoperative hypotony and endophthalmitis are more likely with the 25-gauge vitrectomy, which is why it should not be used in complicated cases, he explained.

Wound closure is “much better with smaller gauges,” particularly when the insertion is done at a 30· angle, he said.

“It’s a good idea to ‘pre-make’ the slit with a blade-like instrument,” Dr. Eckardt suggested. “It helps with the seal.”

Although he said that he would not prefer going much smaller than 25-gauge, he suggested that 27- and even 30-gauge instruments are possibilities in the future.

“The bottom line is the end of 20-gauge is on the horizon,” he said.