<p>Hybrid 23/27 Gauge Vitrectomy – Combining the Charm of 27G with the Efficacy of 23G</p>

Abstract

Background: Minimally invasive transconjunctival sutureless vitrectomy (MIVS) has evolved into the standard of care, smaller incisions thought to result in lower ocular surface trauma and shorter times to recovery. The currently most relevant limitations in macular surgery may be light intensity and 27G instrument stability. Therefore, we thought to compare standard 23 and 27G vitrectomy with a hybrid technique using one 23G and two 27G ports regarding surgical times and short-term outcomes. Methods: This retrospective comparison included 90 single-center consecutive cases of eyes undergoing elective micro-invasive vitrectomy for epiretinal membranes or idiopathic macular holes between October 2017 and June 2018. The main criteria for the comparison were total surgical time as primary outcome parameter and treatment-demanding intra-and postoperative complications along with recovery of best-corrected visual acuity (BCVA) and central retinal thickness (CRT) from prior to surgery to 1 month thereafter as secondary parameters as independent parameters for the recovery from the pre-existing pathology and the surgical trauma. Results: Surgical times were shorter with 23G and 23/27G compared to 27G (23G: 38.4 ±13.1; 27G: 48.1±15.3; 23/27G: 34.9±9 mins; p=0.0005) with no differences in BCVA and CRT outcomes. Switching from 27G to a larger port size was not necessary in any instance. Cryotherapy was applied in 15%, 30%, and 22.5% to suspected retinal pathologies, beyond these, in 5%, 0%, and 7.5% for retinal tears. Four postoperative retinal detachments occurred (4.4%), one in the 23G and three in the 23/27G group requiring re-vitrectomy. Conclusion: In this exploratory case series, 23/27G hybrid vitrectomy, combining the advantages of 23G and 27G techniques, resulted in shorter surgical times without evident disadvantages. The combination with cataract surgery was unproblematic.

<p>Comparison of Characteristics and Clinical Outcomes in 27-Gauge versus 23-Gauge Vitrectomy Surgery</p>

“…It has been suggested that longer vitrectomy times are expected with 27-gauge platforms due to the smaller radius of the cutter's lumen and limited fluid flow rates. 12,[15][16][17] However, several clinical studies have demonstrated similar operation times in 27-gauge vitrectomy compared to its 23-and 25-gauge counterparts. 3,18,19 In our study, 23-gauge surgeries actually lasted slightly longer at a mean of 39 mins compared to 27-gauge surgeries at a mean of 35 mins, although the difference was not statistically significant.…”

Currently Recommended Small Incision Vitrectomies and Bimanual Surgery in Diabetic Vitrectomy

“…Ameliyat sırasında sklerotomi çaplarını değiştirmemek ve sonuçları iyileştirmek için bazı yazarlar, özel cerrahi ihtiyaçlara bağlı olarak farklı boyutlardaki küçük gauge vitrektomi aletlerini karıştırmayı düşünmüşlerdir. [45] Hibrit-gauge vitrektomi, bir vitrektomi vakası sırasında çok sayıda farklı gauge sklerotomi kullanımını içerir. Örneğin, hibrit 20/23G vitrektomi, 23G vitrektomi sırasında planlanmış veya büyütülmüş bir sklerotomi yoluyla 20G'lik bir alet yerleştirildiğinde gerçekleştirilir.…”

Nonperforating Intrascleral Stabbing for Sutureless 23g Sclerotomy Closure

“…However, the stiffness and efficiency of the instruments, which are lost as 23G is avoided, remains another issue worth discussing. 14,15…”

“…However, the stiffness and efficiency of the instruments, which are lost as 23G is avoided, remains another issue worth discussing. 14,15 To date, various efforts to optimize sutureless sclerotomy closure, including scleral wound hydration, application of bioadhesives and polyethylene glycolbased hydrogel bandage, cauterization of sclerotomy sites, wedge-shaped sclerotomies, transconjunctival plain gut tape procedure, scleral needling, refashioning of 23G sclerotomies, and hermetic closure, have been reported. 12,13,[16][17][18][19][20][21][22][23][24][25][26][27][28][29] Although these techniques offer bright perspectives for achieving closure of the sclerotomy, there may be potential limitations for cost and patient discomfort.…”