25-, 23-, or 20-gauge instrumentation for vitreous surgery?

Abstract

Purpose: To discuss the evolution and current status of 25-, 23-, and 20-gauge vitrectomy instrumentation.

Methods: Literature review.

Results: There are multiple small case series describing the surgical techniques, clinical outcomes, and complications associated with 25- and 23-gauge vitrectomy. These studies suggest that small-gauge vitrectomy may shorten operating time, improve patient comfort, and speed visual recovery. However, increased complication rates involving hypotony and endophthalmitis have been reported. There are no level 1 evidence-based studies comparing the efficacy and safety of 25-, 23-, and 20-gauge vitrectomy.

Conclusion: 25- and 23-gauge vitrectomy techniques may shorten operating time, improve patient comfort, and speed visual recovery. However, larger and better designed evidence-based studies are required to better understand relative values of 25-, 23-, and 20-gauge vitrectomy.