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

Authors Garweg JG, Ouassi D, Pfister IB

Received 8 October 2019

Accepted for publication 27 December 2019

Published 31 January 2020 Volume 2020:14 Pages 299—305


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 2

Editor who approved publication: Dr Scott Fraser

Justus G Garweg,1,2 Dean Ouassi,3 Isabel B Pfister1

1Swiss Eye Institute and Berner Augenklinik am Lindenhofspital, Bern, Switzerland; 2Department of Ophthalmology, Inselspital, Bern, Switzerland; 3Medical Faculty, University of Strasbourg, Strasbourg, France

Correspondence: Justus G Garweg
Berner Augenklinik am Lindenhofspital, Bremgartenstrasse 119, Bern CH - 3012, Switzerland
Tel +41 31 311 12 22

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.

Keywords: vitrectomy, hybrid, 27-gauge, surgical time, epiretinal membrane, inner limiting membrane, peeling

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