5 - 27-gauge vitrectomy

Abstract

As microincisional vitrectomy surgery has progressed, smaller and smaller-gauge platforms have been developed while maintaining effective and safe fluidics. Most recently, these improvements have led to 27-gauge platforms. The 27-gauge platforms offer the ability to perform vitrectomy with smaller incisions and even lower rates of suture closure of sclerotomies, as well as less tissue disruption. The smaller probes can more easily access narrow surgical planes such as those in diabetic tractional retinal detachments. However, the smaller-gauge systems are also limited by less instrument stability, which can be a disadvantage for certain techniques such as peripheral shaving of the vitreous and/or peeling of thicker membranes. In addition, the relatively smaller armamentarium of instruments available in 27 gauge may also limit its use for certain cases. The most common indications at present for 27-gauge surgery include vitrectomy for symptomatic floaters, macular surgery, diabetic tractional retinal detachment repair, and/or scleral-fixated intraocular lens surgery. However, 27-gauge platforms have also been employed for primary rhegmatogenous retinal detachment repair as well as complex retinal detachment repairs. It is likely that as the fluidics continue to improve and instrumentation grows, so too will the application of 27-gauge vitrectomy in retinal surgery.