Howard F. Fine, MD (New York, NY), Richard F. Spaide, MD (New York, NY), Reza Iranmanesh, MD (New York, NY), Diana Iturralde, MD (Pamplona, Spain)


Twenty-five gauge vitrectomy systems possess several advantages over 20-g methods including improved wound healing, conjunctival sparing, and patient comfort. Newer 23-g systems were introduced to improve instrument bore size and rigidity while retaining sutureless technique. The purpose of this study is to describe the safety, efficacy, and visual outcomes of 23-g vitrectomy surgery.


All 23-g cases performed by a single surgeon at a single site from 10/2004 to 10/2005 were retrospectively reviewed. Data abstracted included demographic variables, ophthalmic variables, and surgical complications, including retinal tear or detachment, hypotony <= 5mm Hg, and choroidal detachment. The outcome variable, Snellen visual acuity, was converted into a logarithm of the minimal angle of resolution (logMAR). Surgical times were collected prospectively during the final study month. The paired t-test was used to compare means with a statistical significance threshold at p<0.05.


All 76 eyes (41 right, 35 left) of 75 patients (38 female, 37 male) were followed for a minimum of 90 days with a mean follow-up duration of 208 days. The mean visual acuity at baseline was 20/194; at post-operative month one was 20/104 (p=0.0001); at month three was 20/70 (p=0.01); and at final visit was 20/68 (p<0.0001). By diagnosis, patients with macular hole improved from 20/172 to 20/53 (p<0.0001), epiretinal membrane from 20/131 to 20/63 (p=0.0024), rhegmatogenous retinal detachment from 20/285 to 20/55 (p=0.0013), tractional retinal detachment from 20/190 to 20/61 (p=0.0204), and non-clearing vitreous hemorrhage from 20/870 to 20/95 (p=0.0670). The mean opening, closing, and operative times were 103, 75, and 1445 seconds, respectively. There were 2 cases of post-operative hypotony, 11 of subconjunctival hemorrhage, and 1 of presumed endophthalmitis, which was culture negative. There were no choroidal effusions, intraoperative retinal breaks, or secondary retinal detachment.


The rates for sclerotomy leakage, hypotony, choroidal effusion, and secondary retinal tear and detachment appeared similar or superior to previously published rates for 25-g surgery. Overall and diagnosisspecific visual outcomes were highly statistically significant. The 23-g vitrectomy system appears safe and effective for sutureless transconjunctival posterior segment surgery.