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Smaller instrumentation improving vitrectomy
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LISBON, Portugal — The use of 23- and 25-gauge instrumentation for vitrectomy improves patient comfort and postoperative recovery, a speaker here said.
At a scientific session at the Euretina meeting, Stanley Chang, MD, said the advantages of 23- and 25-gauge instrumentation and the improvements made to those vitrectomy systems outweigh their disadvantages.
“I believe 25-gauge primarily offers improvement in comfort and postop recovery,” he said. “The disadvantages are that the cutter is less efficient and there’s an increased cost.”
Among the improvements to the smaller-gauge systems have been the introduction of a xenon light source for improved visualization and of disposable 25-gauge forceps that give the surgeon a larger platform for a firm grasp of tissue, Dr. Chang said.
“I also prefer the new contact lens system, which floats on a layer of Healon GV,” Dr. Chang said. “Earlier versions of 25-gauge systems weren’t very satisfactory, but [with the new system] now we’re using them in straightforward macular surgeries. I use it in 35% of my surgeries.”
Regarding the 23-gauge vitreous cutter, Dr. Chang said, a major advance was the relocation of the port closer to the tip.
“It allows us to get into smaller openings and cling to the membrane,” he said. “The smaller port closer to the tip will allow us to use smaller instruments.”
The 23-gauge also offers improved stiffness compared to the 25-gauge instrumentation, and its flow rates are similar to standard 20-gauge vitrectors, he said.
“In the future I believe we’ll be using 25 gauge for macular surgery and easier cases, and 23 gauge will eventually replace the 25. The improvement of cutters will reduce the need for other instruments,” Dr. Chang said.