Twenty-five-gauge vitrectomy versus 23-gauge vitrectomy in the management of macular diseases: a comparative analysis through a Health Technology Assessment model

Abstract

Small-gauge vitreoretinal techniques have been shown to be safe and effective in the management of a wide spectrum of vitreoretinal diseases. However, the costs of the new technologies may represent a critical issue for national health systems. The aim of the study is to plan a Health Technology Assessment (HTA) by performing a comparative analysis between the 23- and 25-gauge techniques in the management of macular diseases (epiretinal membranes, macular holes, vitreo-macular traction syndrome). In this prospective study, 45-80-year-old patients undergoing vitrectomy surgery for macular disease were enrolled at the Torino Eye Hospital. In the HTA model we assessed the safety, clinical effectiveness, and cost and financial evaluation of 23-gauge compared with 25-gauge vitrectomies. Fifty patients entered the study; 14 patients underwent 23-gauge vitrectomy and 36 underwent 25-gauge vitrectomy. There was no statistically significant difference in post-operative visual acuity at 1 year between the two groups. No cases of retinal detachment or endophtalmitis were registered at 1-year follow-up. The 23-gauge technique was slightly more expensive than the 25-gauge: the total surgical costs were EUR1217.70 versus EUR1164.84 (p = 0.351). We provide a financial comparison between new vitreoretinal procedures recently introduced in the market and reimbursed by the Italian National Health System and we also stimulate a critical debate about the expensive technocratic model of medicine.

Vitreous Substitutes: Old and New Materials in Vitreoretinal Surgery

“…Surgeons have a choice of many tamponades for use with MIVS, each with advantages over the surgical complications associated with 20G vitrectomy, enabling selection appropriate to the underlying disease [45]. …”

Comparison of Recently Used Phacoemulsification Systems Using a Health Technology Assessment Method

“…In certain circumstances an adapted HTA method should be used to meet the specific needs (12). After searching PubMed and the Chinese Wanfang literature database, we identified a few HTA studies that were previously performed in the field of ophthalmology (13), but we believe that our study is the first to report using the HTA method for health technology assessment in Chinese hospitals. The present results can be used as a recommendation for purchasing phacoemulsification systems in China, and the procedures used in the study can help in other medical settings in developing countries so that they can apply HTA methods when deciding on their investment (14).…”

Surgical Management of Epiretinal Membrane

“…The systems that are broadly used for the macula surgery are the 23G and the 25G, while 27G was also recently introduced [45]. The use of either system depends primarily on the surgeon's preference and they do not seem to affect postoperative outcomes [46][47][48][49]. However, the wide acceptance of the microincision systems indicates that these outnumber the 20-g system, offering shorter operating times, reduced corneal astigmatism, diminished conjunctival scarring, improved patient comfort and in some cases, earlier visual recovery [50][51][52].…”