A Propensity-Score Matching Comparison between 27-Gauge and 25-Gauge Vitrectomy Systems for the Repair of Primary Rhegmatogenous Retinal Detachment

Abstract

Purpose To compare the anatomical and visual results and complications of 27-gauge versus 25-gauge transconjunctival sutureless vitrectomy for the management of primary rhegmatogenous retinal detachment. Methods A prospective, propensity score-matched 6-month study was performed. All patients underwent either 27-gauge or 25-gauge vitrectomy as the first surgical intervention and were followed up over a 6-month period, in order to evaluate anatomical success, change in best-corrected visual acuity (BCVA), and intraoperative and postoperative complications including intraocular pressure dysregulation. Results Propensity score matching resulted in two groups of 37 eyes each. All eyes completed a six-month follow-up. Baseline demographic and preoperative ocular characteristics showed no statistically significant difference between the two cohorts. The single operation success rate was 33/37 (89%) for 27-gauge cases and 34/37 (92%) for 25-gauge cases (p=0.7). The final anatomical success rate was 100% for each of the two cohorts. Mean BCVA change at the 6-month postoperative follow-up visit was −0.67 logMAR in the 27-gauge group and −0.71 logMAR in the 25-gauge group (p=0.9). Two patients in the 25-gauge group experienced transient hypotony after surgery. Conclusion No significant difference between 27-gauge and 25-gauge transconjunctival sutureless vitrectomy for the repair of primary rhegmatogenous retinal detachment was recorded in terms of reattachment rate, BCVA, intraoperative and postoperative complications.

Comparison of 27-Gauge and 25-Gauge Microincision Vitrectomy Surgery for the Treatment of Vitreoretinal Disease: A Systematic Review and Meta-Analysis

“…Seven studies [ 15 , 21 – 24 , 26 , 31 ] were designed as prospective randomized/nonrandomized comparative study and four studies [ 17 , 25 , 29 , 30 ] were retrospective randomized/nonrandomized comparative study. Five trials [ 15 , 17 , 21 , 24 , 29 ] enrolled 554 eyes which were conducted on ERM and six studies [ 22 , 23 , 25 , 26 , 30 , 31 ] enrolled 386 eyes which were conducted on RRD. In total, 940 eyes were included in this meta-analysis; 439 eyes were assigned to the 27-G vitrectomy group and 501 eyes to the 25-G group.…”

“…First, in the RRD surgery, peripheral vitrectomy was more strenuous and complicated than in ERM surgery, and as a result, the operation time mostly depends on the proficiency of surgeon rather than the instrument gauges. Second, Veritti et al [ 26 ] reported that the 27-G probe has excellent fluidics procedures and high cut rate (7500 cpm) and it is very effective in shaving peripheral vitreous for RRD cases, so the operation time was not prolonged by smaller gauge in 27-G group. Third, although the qualities of included studies were adequate and the sensitive analysis minimized the heterogeneity as much as possible, the heterogeneity in the ERM subgroup may influence the final result.…”

“…Romano et al [ 23 ] reported that the lower flow rate of 27-G system may influence the operation effectiveness. However, Veritti et al [ 26 ] reported that dual pneumatically operated vitrectomy probes of 27G system with ultrahigh cut rates (7500 cpm) can maintain an efficient vitreous flow rate. For RRD cases, the primary anatomical success rate of included studies ranged from 89% to 97% using 27-G and 85% to 96% using 25-G MIVS and did not differ significantly between two groups.…”

“…Speaking of the safety of the 27-G vitrectomy system, besides being less invasive when compared with 25-G system, 27-G carries additional potential advantages; the shorter but flexible vitrectomy probe generates the shortest attraction distance and a smaller “sphere of influence.” This allows a more accurate fluid control and a greater dissection precision, theoretically allowing for safer procedures with less intro- and postoperative complications compared with 25-G system [ 26 ].…”

“…However, some studies concluded that 27-G vitrectomy requires longer operation time for the treatment of RRD cases because of the lower flow rate. Moreover, 27-G vitrectomy induced more postoperative inflammation because of sutureless wounds [ 20 , 24 – 26 ].…”