Untoward outcomes in 25-gauge versus 20-gauge vitreoretinal surgery

This study compares the incidence of complications in eyes undergoing 25-gauge versus 20-gauge vitreoretinal procedures.

Retrospective case series. A chart review of consecutive patients who underwent primary 25-gauge (129 eyes) and 20-gauge (129 eyes) vitreoretinal surgery by four surgeons at a single center between September 2002 and November 2005 was conducted.

Mean follow-up was 9.1 +/- 4.9 months in 25-gauge eyes and 14.3 +/- 8.4 months in 20-gauge eyes (P < 0.01). Intraoperative complications were mainly rhegmatogenous in nature and occurred at statistically similar incidence (4.7% in 25-gauge eyes, 6.9% in 20-gauge eyes). Postoperative complications that were significantly associated with surgical method included hypotony and serous choroidal effusions (7.9% in 25-gauge eyes, 1.6% in 20-gauge eyes, P = 0.02). Other postoperative complications noted included retinal tears and detachments (5.4% in 25-gauge eyes, 4.7% in 20-gauge eyes), persistent vitreous hemorrhage (5.4% in each group), and new vitreous hemorrhage (3.9% in 25-gauge eyes, 0.8% in 20-gauge eyes). Endophthalmitis was noted only in 25-gauge eyes in 2 cases (1.6%). Cataract progression occurred at similar rates in both groups (46%).

25-gauge surgery is associated with a significantly greater incidence of postoperative serous choroidal effusions and hypotony. Of particular concern in 25-gauge surgery is the increased risk of associated endophthalmitis. Operative indications and case selection may be important in minimizing the tendency toward certain postoperative events.