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25-gauge vs 20-gauge system for pars plana vitrectomy: a prospective randomised clinical trial

Lukas Kellner¹, Barbara Wimpissinger¹, Ulrike Stolba¹, Werner Brannath² and Susanne Binder¹

¹ Department of Ophthalmology, Rudolph Foundation Clinic, Vienna, Austria; Ludwig Boltzmann Institute for Retinology and Biomicroscopic Laser Surgery, Rudolph Foundation Clinic, Vienna, Austria
² Section of Medical Statistics, Medical University of Vienna, Vienna, Austria

Correspondence to:
Correspondence to:
Dr S Binder
Department of Ophthalmology, Ludwig Boltzmann Institute for Retinology and Biomicroscopic Laser Surgery, Rudolph Foundation Clinic, Juchgasse 25, 1030 Vienna, Austria; susanne.binder{at}wienkav.at

Aim: To compare 25-gauge vs 20-gauge system for pars plana vitrectomy in a prospective, randomised, controlled clinical trial.

Methods: Three-port pars plana vitrectomy was performed in 60 patients belonging to 2 groups. Evaluations were performed preoperatively, intraoperatively, during the first three postoperative days, at 1 week, and at 1 and 3 months. The main outcome measure was time for surgery, divided into duration of wound opening, vitrectomy, retinal manipulation and wound closure.

Results: The total duration of surgery showed no significant difference between the groups (p = 0.67). The 25-gauge group showed significantly shorter duration of wound opening (p<0.001) and wound closure (p<0.001). In contrast, the vitrectomy duration was significantly longer in the 25-gauge group (p<0.001). Conjunctival injection and subjective postoperative pain showed significantly lower irritation in the 25-gauge group (p<0.001 for both).

Conclusion: The 25-gauge vitrectomy system offered significantly improved patient comfort during the first postoperative week. The smaller surgical openings facilitated wound healing and minimised pain. Duration of surgery was comparable between the two systems—the shorter time needed for wound opening and closure in the 25-gauge group being equalised by the longer vitrectomy duration. Intraoperative as well as retinal manipulation and illumination caused more surgical difficulties using the 25-gauge system.

Abbreviations: IOP, intraocular pressure

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