25g vs. traditional vitrectomy
February 24, 2009
This issue has been in the news lately, with some singing the praises of one, and some panning the other. Where does the truth lie? Many find the 25 guage to be cumbersome when doing extensive vitrectomies, as it takes longer, but prefer it for smaller cases, like macular hole surgery. And it seems the highere risk of endolphthalmitis is real in 25 guage sutureless surgery, though some surgeons will maintain that if the wounds are constructed carefully, the risk is no higher. I suppose it will take a while before peer-reviewed studies will give us definitive answers, but I was hoping I could hear from retina surgeons in the real world.
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3 Responses to “25g vs. traditional vitrectomy”
Without a doubt, much of the time savings is due to the quick opening and closing. I agree that the instrumentation is slightly limited and not all cases can be considered for 25 gauge. I also find that complicated diabetics and PVR may not all be great candidates.
I also believe that post-operative retinal detachments and tears occur less often than the 20 gauge system for several reasons; the trocars of the 25 gauge system are smaller and allow less vitreous incarceration in the ports and I think there may be some advantages to a quicker cutting rate.
Would love to hear back from you, especially regarding the observation of retinal detachments/tears.
Randall V. Wong, M.D.
Retinal Specialist
http://www.TotalRetina.com
It appears that the big advantage to 25 g vitrectomy is that it takes less time to construct and close the scleral wounds. This time is spent doing a much slower vitrectomy. The only endophthalmitis I have ever had in a vitrectomy was with a 25g sutureless vitrectomy for a macular hole. I still use it for ¨small¨vitrectomies: macular hole, puckers, etc. Not for complicated diabetics or PVR cases. I find that in these, my armamentarium is somehow limited.
I use 25 gauge almost exclusively. Even with some lensectomies, I’ll start out using the 25 gauge and then make a true sclerotomy and “convert” to 20 gauge to use the lens fragmatome. Occasionally with a younger patient, or a retained lens that is now hydrated, you can get away with the 25 vitrector only.
