Lowering risk of 25 G surgery

Although 25 G sutureless vitrectomy has increased in popularity, it is associated with postoperative complications including hypotony, choroidal detachment, and endophthalmitis. Richard Kaiser, MD, from the Retina Service of Wills Eye Institute, Philadelphia, noted that the 25 G procedure has a 12.4 times greater risk of endophthalmitis when compared with the 20 G procedure.

In light of this, the Microsurgical Safety Task Force has disseminated guidelines aiming to reduce the high rate of endophthalmitis associated with 25 G vitrectomy. The measures suggested included: rinsing the lidocaine gel from the ocular surface to allow direct contact of povidone iodine 10% with the conjunctiva; displace the conjunctiva with a cotton tip rather than instruments such as forceps or a caliper, which may cause microholes; use angled, rather than straight-entry, incisions and a tapered exit, to facilitate wound closure and maintenance of preop IOP level; rather than filling the eye with fluid, conduct an air-fluid exchange; and maintain a low threshold for placing a suture at the end of the case.