Twenty-Three-Gauge and 20-Gauge Vitrectomy in Epiretinal Membrane Surgery

In Brief Purpose: The purpose of this study was to investigate the safety profile of the 23-gauge sutureless vitrectomy system in the treatment of epiretinal membranes compared with standard 20-gauge vitrectomy. Methods: A retrospective case comparison of 20-gauge and 23-gauge vitrectomy performed in 167 and 64 eyes, respectively, by the same surgeon. Intraoperative and postoperative complications, duration of surgery, and postoperative visual acuity results were evaluated. Results: Postoperative hypotony occurred significantly more often in the 23-gauge group [9.4% (n = 6) vs. 0% (n = 0), P < 0.001]. With the 23-gauge system, the incidence of retinal detachment was 1.6% (n = 1), vitreous hemorrhage was 0%, and endophthalmitis was 1.6% (n = 1). Patients with 20-gauge vitrectomy developed retinal detachments in 1.8% (n = 3), vitreous hemorrhages in 1.2% (n = 2), and endophthalmitis in 2.4% (n = 4). The mean overall duration of surgery was significantly shorter in the 23-gauge procedures with 23.1 ± 6.5 minutes compared with 34.5 ± 9.1 minutes in the 20-gauge procedures (P < 0.05). At postoperative Day 2, patients with 23-gauge vitrectomy regained preoperative mean best-corrected visual acuity of 20/60. Patients who had 20-gauge vitrectomy experienced a statistically significant decrease of visual acuity from 20/80 to 20/100 (P < 0.05). Conclusion: Twenty-three-gauge vitrectomy in epiretinal membrane surgery is comparable with 20-gauge vitrectomy and is a safe method with a low complication rate. However, the incidence of postoperative hypotony is more frequent using the 23-gauge system. In a retrospective study, 23-gauge vitrectomy was comparable to 20-gauge vitrectomy with respect to postoperative complications in epiretinal membrane surgery. A higher rate of hypotony was observed in the 20-gauge vitrectomy. However, 23-gauge vitrectomy required shorter surgery time and resulted in faster visual acuity recovery.