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Comparative study of 27-gauge and 25-gauge vitrectomy performed as day surgery.

Mori R, Naruse S, Shimada H. Comparative study of 27-gauge and 25-gauge vitrectomy performed as day surgery.
Int Ophthalmol. 2017 Jul 3. doi: 10.1007/s10792-017-0625-0. [Epub ahead of print]

Abstract

PURPOSE:

To compare postoperative outcomes of 27-gauge (G) and 25-G vitrectomy conducted as day surgery.

METHODS:

In total, 200 consecutive eyes that underwent primary vitrectomy (27-G in 100 eyes, 25-G in 100 eyes) were analyzed. 27-G vitrectomy was performed using a cut rate of 7500 cpm and 25-G vitrectomy using a cut rate of 5000 cpm.

RESULTS:

The 27-G and 25-G groups did not differ significantly in underlying diseases and preoperative Early Treatment Diabetic Retinopathy Study (ETDRS) score. The time required for vitrectomy was significantly longer in the 27-G group (35.3 vs. 29.8 min, P = 0.0013). Postoperative hypotony was observed in 0 and 3 patients, and ocular hypertension in 10 and 14 patients in the 27-G and 25-G groups, respectively, showing more stabilized postoperative ocular pressure in the 27-G group. Gain in ETDRS score was significantly better in the 27-G group (12.1 ± 20.2 letters) compared to the 25-G group (10.0 ± 21.3 letters) (P = 0.0323) at 1 month post-vitrectomy, but not significantly different at 3 and 6 months (P = 0.0686 and 0.0543). Rates of postoperative retinal detachment (1 vs. 1%) and vitreous hemorrhage (2 vs. 3%) were not different between two groups.

CONCLUSIONS:

27-G vitrectomy requires longer operative time than 25-G, but using the 27-G system results in earlier visual improvement and stabilized ocular pressure.

27-gauge and 25-gauge vitrectomy day surgery for idiopathic epiretinal membrane.

Naruse S, Shimada H, Mori R. 27-gauge and 25-gauge vitrectomy day surgery for idiopathic epiretinal membrane.
BMC Ophthalmol. 2017 Oct 10;17(1):188. doi: 10.1186/s12886-017-0585-1.

Abstract

BACKGROUND:

This study compared the postoperative outcomes of 27-gauge (G) and 25-G vitrectomy performed for the treatment of idiopathic epiretinal membrane (ERM).

METHODS:

The study design was single center, retrospective, interventional case series. Two hundred consecutive eyes that underwent primary vitrectomy for ERM (27-G vitrectomy in 100 eyes and 25-G vitrectomy in 100 eyes) were studied for 6 months. In all eyes, scleral tunnels were made using angle incisions, and air or gas exchange was performed.

RESULTS:

There were no significant differences in age, spherical diopter power, as well as preoperative Early Treatment Diabetic Retinopathy Study (ETDRS) score, central retinal thickness (CRT), and intraocular pressure between the 27-G and 25-G groups.
The proportions of simultaneous cataract surgery (27-G vs. 25-G: 82% vs. 90%), air-filled eyes (99% vs. 98%), and scleral wound suture at the end of surgery (0% vs. 0%) were not significantly different between two groups. The mean operation time for vitrectomy was significantly (P = 0.0322) longer by 4 min for 27-G (37 min) compared to 25-G (33 min) vitrectomy. Gain in ETDRS score was significantly (P = 0.0421) better in 27-G group (4.7 ± 8.1 letters) compared to 25-G group (1.1 ± 13.6 letters) at 1 month post-vitrectomy, but not significantly different at 3 and 6 months (P = 0.0835 and 0.0569, respectively). Decrease in CRT was significantly (P = 0.0354) greater in 27-G group (-24.2 ± 50.0 μm) compared to 25-G group (-8.0 ± 48.6 μm) at 1 month post-vitrectomy, but not significantly different at 3 and 6 months (P = 0.6059 and 0.1725, respectively). On postoperative day 1, hypotony (≤ 6 mmHg) was observed in 2 eyes in 27-G group and 6 eyes in 25-G group, while ocular hypertension (≥ 25 mmHg) was found in 4 eyes in 27-G group and 11 eyes in 25-G group, with no significant differences between two groups. Postoperative complications requiring treatment occurred in one eye (vitreous hemorrhage) in 27-G group, and in two eyes (vitreous hemorrhage and retinal detachment in one eye each) in 25-G group.

CONCLUSIONS:

Although 27-G vitrectomy requires operation time of 4 min longer compared to 25-G vitrectomy for ERM surgery, using the 27-G system results in earlier recovery of visual acuity, CRT improvement and stabilized ocular pressure.

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