Study finds faster visual recovery from 25- vs. 20-gauge macular hole surgery

Macular hole surgery performed using 25-gauge vitrectomy instruments can result in significantly better visual outcomes during the first 9 months postop compared with surgery involving 20-gauge instruments, according to a study published in the March issue of Acta Ophthalmologica.

"[Performing] 25-gauge vitrectomy has several advantages: It is less invasive to the ocular surface, requires less surgical time and uses a lower volume of irrigating fluid. All of these differences benefit the ocular surface and the neural retina, which may then result in better and earlier functional recovery after surgery," the study authors said.

Makoto Inoue, MD, and colleagues at Keio University School of Medicine, Tokyo, reviewed the medical records of 46 eyes treated with vitrectomy for macular holes. The operating surgeon initially used a 20-gauge system for the first 23 eyes and then switched to a 25-gauge system for the latter 23 eyes.

Both groups were similar in mean age and preoperative macular hole stage. Also, both groups had similar baseline logMAR visual acuities, which averaged 0.72 in the 25-gauge group and 0.68 in the 20-gauge group, according to the study.

At 1 week follow-up, the 25-gauge vitrectomy group showed a significantly better improvement in vision, with logMAR visual acuity averaging 0.4 vs. 0.58 in the 20-gauge group (P = .02).

"This significant difference was maintained until 9 months after surgery, but was no longer evident at 12 months," the authors said.

The 25-gauge group also had a significantly shorter operating time and required significantly less irrigating fluid, they noted.

Operating time averaged 56 minutes in the 25-gauge group compared with 85 minutes in the 20-gauge group (P = .003).

Irrigating fluid volume averaged 244 mL for 25-gauge surgery and 416 mL for 20-gauge surgery (P < .0001), according to the study.