To compare the benefits, the risks and the dynamics of port closure in different gauge vitrectomy systems.
Prospective, randomized, comparative study of 90 eyes undergoing 20, 23 and 25 gauge (G) vitrectomy for uncomplicated vitreous hemorrhage due to proliferative diabetic retinopathy, vasculitis, trauma, venous occlusions and others. An endoscope was used in five cases of each group to visualize the inside of sclerotomy ports.
Vision improved from 0.048 (3/60) to 0.206 (6/24) (p = 0.0021), from 0.069 (4/60) to 0.389 (6/18) (p < 0.0001) and from 0.055 (3/60) to 0.286 (6/24) (p = 0.0010) with 20, 23, and 25-G systems, respectively. Re-bleeds occurred in 4, 1 and 4 eyes of 20, 23 and 25-G systems respectively and post-operative retinal detachment was seen in 2 cases of 20-G system. There were no cases of post-operative hypotony or endophthalmitis seen. With 23 and 25 gauge systems, significant amount of vitreous was seen blocking the inner lip of the sclerotomy ports.
The small gauge systems are safe and equally effective than the 20-G system for non-complicated vitreous hemorrhage cases with faster recovery and more comfort for the patient. Increased vitreous clogging with small gauge systems does not extrapolate to an increased risk of complications.