Faster recovery after 25G than 20G vitrectomy

Twenty-five gauge (25G) microincision vitrectomy surgery (MIVS) can produce the same functional prognosis as conventional 20gauge (20G) vitrectomy in patients with proliferative diabetic retinopathy (PDR), but as the procedure is less traumatic for the eye, it reduces postoperative inflammation, induced astigmatism and patient discomfort, it is believed to result in faster recovery time compared with 20G vitrectomy. This means that MIVS has the potential to relieve the financial and temporal burdens of surgical treatment for PDR, representing great progress in the treatment of this complex vitreoretinal condition.

However, despite these advancements and despite the fact that 25G MIVS has now completely replaced 20G vitrectomy in some hospital settings, concrete data about the postoperative recovery period in the cases that underwent 25G MIVS had not previously been available. Therefore, Dr Tatsuhiko Sato (Osaka Rosai Hospital, Japan) and his team conducted a study¹ to compare outcomes between the two procedures; specifically, they measured the duration of postoperative hospitalization (chosen as the index of postoperative recovery period) after 25G MIVS and compared it to that following 20G vitrectomy.

The team studied 159 eyes; the first group (n = 72) underwent 20G vitrectomy while the second group (n = 87) underwent 25G vitrectomy. There were no significant differences in patient demographics or preoperative ocular status between the two groups. All procedures were conducted by the same two experienced surgeons, working in a hospital that performs around 1000 vitreoretinal surgeries per year.

The researchers compared the surgical procedures and postoperative functional and anatomical outcomes between the two groups. Patients were permitted to be discharged from hospital when they displayed no signs of infection for five consecutive days after the vitrectomy, had no discomfort and no postoperative complications, such as retinal detachment and nonclearing vitreous haemorrhage. Eyes with vitreous cavities that were still filled with silicone oil at the last examination (baseline + ≥6 months) were classified as anatomical failures.