Carl D. Regillo, MD, FACS (Philadelphia, PA),* Omesh Gupta, MD (Philadelphia, PA), Allen C. Ho, MD (Wyndmoor, PA), Richard S. Kaiser, MD (Wyndmoor, PA), Mitchell S. Fineman, MD (Cherry Hill, NJ), James F. Vander, MD (Wyndmoor, PA), J. Arch McNamara, MD, FRCS(C) (Wyndmoor, PA)


To report surgical outcomes and both intraand postoperative complications in a large series of eyes undergoing 25-gauge pars plana vitrectomy (PPV).


A retrospective, single practice, interventional case series of 70 consecutive eyes that recently underwent 25-gauge PPV at Wills Eye Hospital using the latest Alcon Accurus system for a variety of indications including, but not limited to epiretinal membrane, vitreous hemorrhage, macular hole, and retinal detachment. Only primary, 3-port vitrectomies with a minimum postoperative follow-up of 12 weeks were included. Main outcome measures included Snellen visual acuity (VA), anatomical results, intraocular pressure (IOP), intraoperative complications, and postoperative complications.


The mean follow-up was 22 weeks (range, 12 to 38 weeks). The overall visual acuity improved from 20/368 (range, 20/25 – hand motions) preoperatively to 20/105 (range, 20/20 – counting fingers) postoperatively (p<0.00005). All subgroups had statistically significant vision improvement. Intraoperative complications included retinal tears in 2 eyes (2.9%).
Postoperative complications included cataract progression in 17 eyes (42.5%), CME in 5 eyes (7.1%), and retinal detachment in 1 eye (1.4%). Postoperative day 1 IOP measurements were statistically lower than preoperative IOP measurements in fluid-filled eyes (p=0.031). There was no significant difference in preoperative and postoperative day 1 IOP measurements in eyes with intravitreal air (p=0.30) or gas (p=0.52). Sclerotomy sutures were required intraoperatively in five eyes (7.1%) and postoperative day 1 hypotony was noted in 4 eyes (5.7%). No postop interventions were required other than for the 1 eye with RRD.


Surgical results were good and complications were rare in this series of 25-gauge PPV. Postoperative cataract progression and hypotony were the most common complications. Retinal tear or detachment was a rare complication in the intraoperative and postoperative setting. Fluid-filled eyes after 25-gauge PPV appear to have a higher risk of postop hypotony than air/gas-filled eyes.
* Financial interest disclosed