Well known are “cosmetic” advantages of small gauge surgery, namely 25ga (shorter procedure, patients´ comfort, less inflammation, no astigmatism), however, more important are the “surgical” advantages (smaller required flow, smaller risk of retina or vitreous incarceration, better surgical accuracy, almost no retinal tears, a single instrument for various manipulations: base dissection, delamination, segmentation (suck+elevate+cut), retinotomy and retinectomy, SRF drainage, A/F exchange, posterior capsulotomy, vacuum peeling of membranes, including the ILM, almost avoiding the need of other instruments (scissors, backflush cannula, sometimes even the forceps). Concerns with flexure of instruments, post-op hypotony or endophthalmitis are no more relevant. Post-op retinal detachment is less frequent that using the 20 ga technique.


Sharing personal experience with 25ga+ surgery in diabetic retinopathy using the Constellation machine. Showing surgical videos, precise manipulations with vitrectomy cutter, avoiding the need of scissors and forceps.


These advantages lead to a better safety of the surgery. The most important is the less frequent retinal detachment after vitrectomy.

Take Home Message:

25ga+ technique represents not only equally safe surgery but it is a real progress.



Ivan Fišer, Filip Brázda, Martina Rubešová
Lexum European Eye Clinic
Prague, Czech Republic