Study Finds 20-Gauge Vitrectomy Comparable to 25-Gauge

February 18, 2010

As reported in the BJO, pain and operating times were comparable between the 20 and 25-gauge vitrectomy systems.  4o patients were randomized to either vitrectomy system and polled regarding pain.  Operating times, IOP and pain were assessed.

The authors found that the opening times for 25-gauge systems were faster, but the larger, 20-gauge systems completed the vitrectomy faster.  There was more hypotony in the sutureless, 25-gauge system, but none required further surgery.  While there was more pain reported in the 20-gauge system, pain was not felt to be a significant factor in either group.

25 gauge vitrectomy was developed with the idea that a smaller “sutureless” system could replace the larger, traditional, 20-gauge systems.  The larger systems require conjunctival resections and sutured closures, not to mention sutured sclerotomy closure.  The thinner, 25 -g systems require quick stab incisioins and no sutures for closure.

In short, the 25 gauge systems offer quicker openings and closures.  The time required for the vitrectomy, however, is increased due to the smaller port size of the vitreous cutter and smaller diameter of the cutter shaft.

The authors concluded that there was no significant advantage in 25 gauge for either patients or surgeons.

What Does This Mean?  As a retina specialist, I am quite biased as I use, almost exclusively, 25 gauge instrumentation.  I find it quicker in all areas of the operation.  My average surgical times, at the same center, dropped significantly when switching to the smaller system.  This seems a fairer way to assess any surgical advantage.  It removes any bias in terms of case selection, surgical endpoints, variance between surgeons, etc.

My own patients that have had both 20 and 25 gauge vitrectomy unanimously prefer the 25 gauge system noting post-operative comfort as a huge difference.  A similar study would be really helpful in measuring subjective “pain.”  It could still be randomized to the patient.

Lastly, the study finds no advantage for either system, but only reviewed information for the first post-op week.  I find that the transconjunctival 25 gauge systems, that require no cutting or suturing, require far fewer post-operative visits.

This doc is going to keep using the 25 gauge systems.

Any comments?

Randall V.Wong, M.D.

Retina Specialist
Fairfax Virginia




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