Comparison of 27-Gauge to 25-Gauge Vitrectomy in Patients with Tractional Retinal Detachment Associated with Proliferative Diabetic Retinopathy

Abstract

Background/Objectives: To compare the surgical outcomes of 25-gauge (G) vitrectomy to those of 27G vitrectomy for proliferative diabetic retinopathy (PDR) with a tractional retinal detachment (TRD). Methods: Eighty-three consecutive eyes of 71 patients with PDR and TRD that underwent initial vitrectomy at the Kyorin Eye Center from June 2021 to August 2023 and were followed for ≥3 months were studied retrospectively. The surgical outcomes of the 10,000 cut/min (cpm) 25G vitrectomy (25G group, 25 eyes) to that of the 20,000 cpm 27G vitrectomy (27G group, 58 eyes) were compared. Results: The preoperative PDR status, surgical procedures, and postoperative outcomes were assessed relative to the surgical success. The 25G group had significantly more eyes with severe PDR (p = 0.010), no prior laser photocoagulation (p = 0.027), macular detachment (p = 0.006), and the use of bimanual technique (p = 0.005). However, the operative times and incidence of iatrogenic breaks were not significantly different. The visual acuity improved significantly in both groups at 3 months postoperatively. The primary anatomical success was 88% in the 25G and 97% in the 27G groups (p > 0.05). The risk factors for a postoperative retinal detachment were significantly associated with the grade (p = 0.042) and type of PDR (p = 0.041), the use of perfluorocarbon liquid (p = 0.028), and bimanual techniques (p = 0.017). Conclusions: The high anatomical success for both groups for TRD secondary to PDR indicates that both can be used to treat eyes with PDR. The 27G vitrectomy may reduce the need for bimanual techniques.

Keywords: 25-gauge; 27-gauge; proliferative diabetic retinopathy; tractional retinal detachment; twin duty cycle; vitrectomy.

Figure 1

Magnified images of a 27-gauge dual-blade vitreous cutter. (A) The opening port of an outer tube is fully opened, and an inner tube of the cutter is located behind the opening port. (B) The opening port of the outer tube is closed by the movement of the inner tube forward (arrow). The inner tube has another opening port (arrowhead) that enables fluid or vitreous to be aspirated. (C) The opening port of the outer tube is closed by the movement of the inner tube forward (arrow). However, the inner tube has another opening port (arrowhead) that enables fluid or vitreous to be aspirated. This indicates a twin-duty cycle system. On the other hand, a single-blade cutter has no opening port in the inner tube, so when the inner tube is closed, the aspiration is stopped.

Figure 2

Surgical images during surgery for proliferative diabetic retinopathy with 25-gauge or 27-gauge vitrectomy. (A) A fibrovascular membrane is dissected with a 27-gauge dual-blade cutter by inserting the tip of the vitreous cutter beneath the fibrovascular membrane. (B) A bimanual technique is used with scissors and forceps of 25-gauge instruments. The fibrovascular membrane is held with the forceps and dissected with scissors in an eye with retinal detachment associated with a tractional membrane complicated by retinal breaks.