Study: Higher postop complication rate with 25- vs. 20-gauge vitreoretinal surgery

Patients who undergo 25-gauge vitreoretinal surgeries may have a significantly higher risk of postoperative serous choroidal effusion and hypotony compared with patients treated with 20-gauge procedures, according to a retrospective study.

The 25-gauge procedures may also increase the risk of endophthalmitis, the study authors noted.

Saad Shaikh, MD, and colleagues compared complication rates between two groups of 129 eyes treated with primary 25-gauge or 20-gauge vitreoretinal surgery. All procedures were performed by four surgeons at a single center between September 2002 and November 2005, according to the study.

Follow-up averaged 9.1 months in the 25-gauge group and 14.3 months in the 20-gauge group.

Investigators found that both groups had similar rates of intraoperative complications, which were mainly rhegmatogenous in nature. Specifically, intraoperative complications occurred in 4.7% of the 25-gauge group and 6.9% of the 20-gauge group.

Also, 46% of eyes in both groups experienced cataract progression.

However, eyes treated with 25-gauge procedures had a significantly higher incidence of postoperative complications. In particular, 7.9% of 25-gauge-treated eyes developed hypotony and serous choroidal effusions compared with 1.6% of 20-gauge-treated eyes (P = .02), according to the study.

Other postoperative complications included retinal tears and detachments in 5.4% of 25-gauge eyes and 4.7% of 20-gauge eyes, new vitreous hemorrhage in 3.9% of 25-gauge eyes and 0.8% of 20-gauge eyes and persistent vitreous hemorrhage in 5.4% of eyes in both groups.

Two eyes (1.6%) in the 25-gauge-treated group also developed endophthalmitis; no eyes in the 20-gauge-treated group experienced this complication, the authors noted.

"Operative indications and case selection may be important in minimizing the tendency toward certain postoperative events," they said.

The study is published in the October issue of Retina.