Comparative study of the short-term results of 27-gauge versus 25-gauge microincision vitrectomy for vitreoretinal diseases

Abstract:

AIM:To compare the short-term surgical results of 27-gauge(27G)with 25-gauge(25G)microincision vitrectomy surgery(MIVS)for the treatment of vitreoretinal diseases and evaluate the feasibility, safety and effectiveness of 27G MIVS.

METHODS:Two hundred and seventeen eyes with various vitreoretinal diseases underwent 27G or 25G MIVS from April 2016 to October 2017 and were retrospectively reviewed. One hundred and thirty-five eyes underwent 27G vitrectomy and 82 eyes for 25G vitrectomy. The main outcome measurements of the study included surgical time, intraoperative complications, postoperative ocular inflammation reaction, short-term best corrected visual acuity(BCVA, LogMAR)recovery and intraocular pressure fluctuation.

RESULTS:All surgeries were completed successfully, and no eye in 27G group needed conversion to 25G vitrectomy. The mean surgical times in the 25G group was 56.4±38.9 min, which was significant longer than that of 27G group(45.5±26.1 min, t=2.422, P=0.016). However, when comparing the surgical time for each category of disease, there were no significant differences observed(P>0.05). Within the first week postoperatively, the mean cumulative score of conjunctival congestion, anterior chamber flare and aqueous cell in 25G group were 2.4±1.4, 0.7±1 and 0.5±1, which were higher than those in 27G group(2.1±1.6, 0.3±0.6, and 0.2±0.4), with significant differences(P=0.038, P=0.011, P=0.046 respectively). The improvement of BCVA was -0.4±0.9 in 25G group, and -0.2±0.9 in the 27G groups respectively(t=-1.636, P=0.103). The rate of transient ocular hypotony of the 25G vitrectomy was 19.5%(16 eyes), which was higher than that of the 27G group without significant difference(15.6%, 21 eyes; χ²=0.565, P=0.452). When the eyes injected with silicone oil were excluded, there was no significant difference in intraocular pressure fluctuation between the 25G group(3.59±0.69mmHg)and the 27G group(3.58±0.47mmHg; t=0.007, P=0.995).

CONCLUSION: The 27G microincision vitrectomy can be used to treat various vitreoretinal diseases. It is a safe and effective surgical procedure with small incision and mild anterior segment inflammatory reaction.

Key words:27-gauge; 25-gauge; microincision vitrectomy surgery; vitreoretinal disease