20G Group Research Articles

Deflection of Needles, Used for Local Anesthesia in the Dental Practice – Comparative Study

The mandibular nerve blocks prove to be one of the most challenging anesthetic techniques for the dental practitioner. Many factors have a role in the success of these nerve blocks and one of them is the accuracy of the deposition of the anesthetic which can be influenced to a certain degree by the deflection of the injection needle. In this study, three types of injection needles (Septoject XL 30G, Septoject XL 27G and Medoject 23G) were tested for deflection in a reversible hydrocolloid (agar-agar). They were divided into three groups of 30 needles each and were all inserted in the agar-agar at a depth of 20 mm with the help of a dental surveyor. Two mutually perpendicular radiographs were made for each needle in order to calculate the deviation in mm. The results were analyzed and showed that the mean deflection in the 30G needles group was 5.32±1.91 mm, the deviation in the 27G group – 3.37±0.67 mm and none of the needles in the 23G group showed a deviation upon insertion in the hydrocolloid. The results in this study showed that dentists should always prefer needles with a smaller gauge, because they provide smaller deflection figures and therefore better accuracy in the deposition of the anesthetic.

PRESERFLO™ Microshunt: 1-Year Results of a 25-Gauge vs. 27-Gauge Needle Tract.

Background: The purpose of this study was to evaluate the effectiveness and safety of the PreserFlo™ microshunt (PMS) using a 25-Gauge vs. 27-Gauge needle tract. Methods: This is a prospective postoperative examination of 60 glaucoma eyes that received a PMS. The main outcome measures were intraocular pressure (IOP), glaucoma drug score (GDS), Kaplan-Meier success rates, complications, and secondary intervention rates. Two subgroups were formed for data comparison: 27-Gauge (27G), and 25-Gauge (25G). Success was defined as IOP < 18 mmHg together with ≥20% IOP reduction with medication allowed (qualified success = QS18) or not (full success = FS18). Results: IOP and GDS were reduced from baseline to the 1-year study visit as follows: All eyes from 23.4 ± 8.6 mmHg (3.1 ± 0.9) to 15.1 ± 5.9 mmHg (0.8 ± 1.1); 25G from 24.2 ± 7.3 mmHg (3.0 ± 0.8) to 12.7 ± 2.7 mmHg (0.5 ± 0.8); and 27G from 23.1 ± 9.2 mmHg (3.1 ± 1.0) to 16.2 ± 6.7 mmHg (0.9 ± 1.2). IOP at one year was lower in the 25G group compared to the 27G group (p = 0.035). Bleb needling was required in eight (13.3%) eyes and open bleb revisions in three (5.0%). Transient hypotony occurred in 21% and choroidal effusion in 8% of all eyes. Choroidal effusions were more frequent in the 25G group (21%) compared to the 27G group (2%, p = 0.031). One-year success rates were significantly higher in the 25G group compared to the 27G group for both QS18 (25G: 67.9% vs. 27G: 35.7%, p = 0.002) and FS18 (25G: 63.6% vs. 27G: 29.2%, p = 0.007). Conclusions: The PreserFlo microshunt is an effective and safe glaucoma surgery with a low rate of bleb revisions or needlings. We show that the 25G needle tract might be more efficient for IOP control at the cost of increased IOP-related complications compared to 27G.

25-GAUGE VERSUS 27-GAUGE VITRECTOMY FOR MANAGEMENT OF VITREORETINAL DISEASES: A Large Prospective Randomized Trial.

To compare the safety and performance clinical outcomes of the 27-gauge (G) two-dimensional cutting vitrectomy probe versus a standard 25-G probe for retinal procedures. In this large randomized prospective study, all candidates for epiretinal membrane or macular hole surgery were randomized to the 27-G group or 25-G group. Outcome measures included surgery time, changes in best-corrected distance visual acuity, intraocular pressure, and central macular thickness between baseline and 1-month and 3-month follow-up time points. Moreover, intraoperative and postoperative complications were evaluated as well as the rate of sutureless vitrectomy. A total of 463 patients were included in this study, 227 patients in the 27-G group and 236 patients in the 25-G group. A similar total surgery time was found between both groups ( P = 0.0911). Similar best-corrected distance visual acuity and central macular thickness changes were observed between baseline and the 1-month and 3-month follow-up visits. No significant differences were reported in intraoperative and postoperative complications rates. The rate of sutureless vitrectomy was 96.5% for the 27-G group and 91.1% for the 25-G group ( P = 0.0170). These results suggest that 27-G vitrectomy probe is similar to 25-G probe in surgery time and complications, while decreasing the need for vitrectomy sutures.

Comparison of Cytological Adequacy between 23- and 25-Gauge in Ultrasound-Guided Fine-Needle Aspiration of Thyroid Nodules: A Single-Center Prospective Study.

Approximately 15% of fine-needle aspiration (FNA) of thyroid nodules are considered nondiagnostic. Several factors are potentially involved, including clinical and nodule features but also the gauge (G) of the needle used. However, few studies have compared the cytological adequacy obtained with different gauge needles and the data are controversial. We aimed to evaluate cytological adequacy results using 23- or 25-G needles. This study is an observational and prospective study of thyroid nodules submitted to ultrasound-guided FNA. The procedure was performed randomly using 23- or 25-G needles. The samples were reported by different cytopathologists who were blinded to the information of the gauge of the needle used. Statistical analysis was performed to compare cytological adequacy of FNA between the two groups. A total of 177 thyroid nodules were included - 98 (55.4%) using 23-G and 79 (44.6%) using 25-G needles. The 23-G group presented a higher rate of cytological adequacy (69.4% [68/98] vs. 46.8% [37/79], p = 0.002). No differences were found between the two groups regarding patient or nodule characteristics. On logistic regression, 23-G needles correlated with better cytological adequacy (unadjusted OR 2.57 [95% CI: 1.39-4.77]), even after adjusting for nodule dimension, location, and type of cytology (slides +/- additional liquid-based cytology) (adjusted OR 2.44 [95% CI: 1.23-4.84]). The gauge of the needle used was found to be an independent predictor of cytological adequacy, with 23-G needles providing more adequate samples. Further investigation is needed to confirm our results in order to stablish the optimal diagnosis technique.

Comparison of 27-gauge beveled-tip and 25-gauge flat-tip microincision vitrectomy surgery in the treatment of proliferative diabetic retinopathy: a randomized controlled trial

PurposeTo compare the effectiveness and safety of a 27-gauge (27G) beveled-tip microincision vitrectomy surgery (MIVS) with a 25-gauge (25G) flat-tip MIVS for the treatment of proliferative diabetic retinopathy (PDR).MethodsA prospective, single-masked, randomized, controlled clinical trial included 52 eyes (52 patients) with PDR requiring proliferative membrane removal. They were randomly assigned in a 1:1 ratio to undergo the 27G beveled-tip and or 25G flat-tip MIVS (the 27G group and the 25G group, respectively). During surgery, the productivity of cutting the membrane, the number of vitrectomy probe (VP) exchanges to microforceps, total operation time, vitrectomy time and intraoperative complications were measured. Best-corrected visual acuity (BCVA), intraocular pressure (IOP) and postoperative complications were also assessed to month 6.ResultsForty-seven eyes (47 patients) completed the follow-up, including 25 in the 27G group and 22 in the 25G group. During surgery in the 27G group, cutting the membrane was more efficient (P = 0.001), and the number of VP exchanges to microforceps was lower (P = 0.026). The occurrences of intraoperative hemorrhages and electrocoagulation also decreased significantly (P = 0.004 and P = 0.022). There were no statistical differences in the total operation time or vitrectomy time between the two groups (P = 0.275 and P = 0.372), but the former was slightly lower in the 27G group. Additionally, the 27G group required fewer wound sutures (P = 0.044). All the follow-up results revealed no significant difference between the two groups.ConclusionsCompared with the 25G flat-tip MIVS, the 27G beveled-tip MIVS could be more efficient in removing the proliferative membrane while reducing the occurrence of intraoperative hemorrhages and electrocoagulation using appropriate surgical techniques and instrument parameters. Its vitreous removal performance was not inferior to that of the 25G MIVS and might offer potential advantages in total operation time. In terms of patient outcomes, advanced MIVS demonstrates equal effectiveness and safety to 25G flat-tip MIVS.Trial registrationThe clinical trial has been registered at Clinicaltrials.gov (NCT0544694) on 07/07/2022. And all patients in the article were enrolled after registration.

Spiced RCT: Success and Pain Associated with Intravenous Cannulation in the Emergency Department Randomized Controlled Trial

BackgroundPeripheral venous cannulation is one of the most common procedures in medicine. A larger cannula allows higher rates of fluid to be provided if needed in a deteriorating patient; however, it is also perceived that larger-gauge cannula placement is associated with increased pain and procedural difficulty. ObjectiveThis study aimed to compare the pain and procedural difficulty experienced during insertion between 18-gauge (18G) and 20-gauge (20G) cannulas. MethodsWe conducted a single-blinded, randomized controlled trial on adult patients who required peripheral IV cannulation within a tertiary hospital emergency department between April and October 2018. Patients were randomized to either the 18G or 20G cannula group. The primary outcomes of the study—pain experienced by patients and procedural difficulties experienced by clinical staff—were recorded on two separate 10-cm visual analog scales. Other outcomes include first-attempt success rate, operator designation, complications, and the intent and actual use of the IV cannula were documented on preformatted questionnaires. ResultsData from 178 patients were included in the analysis. Eighty-nine patients were allocated to each cannula group. There were no statistically or clinically significant differences between mean pain score (0.23; 95% CI 0.56–1.02; p = 0.5662) and mean procedural difficulty score (0.12; 95% CI 0.66–0.93; p = 0.7396). between the two groups. There was no difference in first-attempt success rate (73 of 89 vs. 75 of 89; p = 0.1288), complications (2 of 89 vs. 1 of 89) between the 20G group and 18G group, respectively. ConclusionsThere was no significant difference between the 18G or 20G cannula for either pain experienced by patients or procedural difficulty experienced by clinicians.

Clinical Experience of Two Sutureless Intrascleral Fixation Techniques for Secondary Intraocular Lens Implantation

Introduction: The aim of this study was to evaluate the outcome of the modified Carlevale intraocular lens (IOL) fixation technique, using two different vitrectomy ports (23- vs. 27-gauge) as anchor fixation. Methods: Retrospective, consecutive study of 282 eyes (282 patients) who underwent a secondary IOL implantation using the Carlevale IOL (Soleko IOL Division, Italy) with two anchor haptics for intrascleral implantation with either 23- or 27-gauge (G) port. Results: Transient post-operative ocular hypotonia (intraocular pressure ≤5 mm Hg) was observed less in the 27-G group (13 vs. 4 patients, p = 0.057) three requiring additional tunnel sutures (2 cases for 23-G; 1 case 27-G). Post-operative vitreous haemorrhage was recorded more often in the 23-G group (8 vs. 1 patient, p = 0.034), but all cases in both groups resolved without intervention. Visual acuity did improve post-operatively in the two groups. No post-operative complications such as retinal detachment, endophthalmitis, and IOL-dislocation tilt were observed in the follow-up. Conclusion: The 27-G modified technique for sutureless intrascleral implantation is simple and effective and causes less post-operative hypotony.

27‑Gauge vitrectomy vs. 25‑gauge vitrectomy in the management of proliferative diabetic retinopathy with preoperative intravitreal injection of conbercept.

Small-gauge vitrectomy has become popular due to its notable advantages, including less trauma, shortened convalescence and improved manoeuvrability. The aim of the present study was to compare the surgical outcomes of 27-gauge (27-G) vitrectomy with those of 25-gauge (25-G) vitrectomy in the management of proliferative diabetic retinopathy (PDR) with preoperative intravitreal injection of conbercept. The data of 48 consecutive patients with PDR (48 eyes) were retrospectively collected. The patients underwent conbercept intravitreal injection and pars plana vitrectomy with a 27-G group (23 eyes) or 25-G group (25 eyes) vitrectomy system. The operating time, suturing rate, endodiathermy rate, postoperative best-corrected visual acuity (BCVA), intraocular pressure (IOP) and complications were recorded. The mean postoperative BCVA at final follow-up was significantly improved compared with that at the baseline in both groups (P<0.001 for both). The differences in the mean BCVA changes between the two groups were not significant (P>0.99), and no differences were observed in the final central foveal thickness (P=0.51) between the two groups. The final IOP remained stable compared with that at the baseline in the 27-G group (P=0.36) and the 25-G group (P=0.05). The suturing rate was significantly decreased in the 27-G group compared with the 25-G group (P=0.04). There were no significant differences between the two groups in terms of the operating time (P=0.18), rate of endodiathermy use (P>0.99), iatrogenic retinal breaks (P=0.42) or postoperative recurrent vitreous haemorrhage (P>0.99). In addition, no case of ocular hypotony was observed in either group. In conclusion, 27-G vitrectomy was as efficient and safe as 25-G vitrectomy in the management of PDR in terms of operating time and complications. With reference to the literature, preoperative conbercept injection appears to assist in decreasing the incidence of intraoperative and postoperative complications.

Postdural puncture headache incidence with 25G and 27G Quincke needles after spinal anesthesia for elective cesarean section

Background: Post dural puncture headache(PDPH) is a bilateral occipito-frontal headache occurs in 0.1 to 36% of cases receiving spinal anesthesia. We evaluated the incidence of PDPH after spinal anesthesia using two commonly used needles, 25G and 27G Quincke needles among females undergoing elective cesarean section. Aims and Objectives: The aim of the study was to compare the post-dural puncture headache with 25G And 27G Quincke Needle – in terms of Incidence, severity in patients after spinal anesthesia for elective caesarean section and to find out number of attempts for successful block and any associated complications. Materials and Methods: Six hundred females of ASA grade I or II posted for elective cesarean section under spinal anesthesia were enrolled into two equal groups to assess incidence of PDPH in the post-operative period. They were assessed by a blinded observer for the onset of headache, characteristics, duration, severity, and any associated symptoms for 5 days. PDPH was defined as postural headache that was aggravated by sitting or standing position and relieved by lying supine. Results: The incidence of PDPH was 11% in 25G needle group and 6.33% in the 27G needle group [Risk Ratio of 0.58 (95% CI: 0.34, 0.99)]. In none of the groups, intensity of headache was severe while all were mild in the 27G group. Nausea and vomiting were the only associated symptomatology, 7.33% in the 25G group and 5.67% in the 27G group. Conclusion: The results support 27G Quincke needle to administer spinal anesthesia in females undergoing elective cesarean section.

Post Dural Puncture Headache After Elective Caesarean Section Using 27 G Quincke and Whitacre Spinal Needles: A Comparative Study

INTRODUCTION&#x0D; Post-dural puncture headache (PDPH), a serious complication of spinal anesthesia (SA) may persevere for long time and can be unbearable to the patients. The incidence of PDPH unswervingly relies on the size of the spinal needles used and this gradually decreases with the use of thinner spinal needles.&#x0D; &#x0D; MATERIAL AND METHODS&#x0D; A prospective randomized single blinded study was conducted during the period between 1 to 29 January 2019, at Universal College of Medical Sciences, Nepal. A total of 120 patients (between 20-35 years of age) were divided into two groups: Group I: 60 patients given SA with 27-G Quincke needle and Group II: 60 patients given SA with 27-G Whitacre. Randomization was done by coin tossing method and double-blinded except for the anesthetist performing the spinal block. Patients were interviewed on days 1 to 5 and were questioned with regard to headache based on its severity, location, character, duration, associated symptoms (nausea, vomiting, auditory and ocular symptoms). The severity of the headache was analyzed by Crocker scale.&#x0D; &#x0D; RESULTS&#x0D; The results showed that 33% more headache in group A, but the t-value was 0.727 and p-value was 0.2345 which was statistically insignificant.&#x0D; &#x0D; CONCLUSION&#x0D; Hence, using 27-G Quincke spinal needles does appear to be advantageous to the patients whereas, Whitacre spinal needles are shown to be clearly associated with fewer cases of PDPH.

A Blinded Randomized Trial Comparing 2 Needle Gauges for Fine-Needle Biopsy of Thyroid Nodules.

ObjectiveTo compare diagnostic capability and patient pain between 25-gauge (25G) and 27G needles for ultrasound-guided fine-needle biopsy of thyroid nodules.Study DesignProspective blinded randomized trial.SettingThyroid clinic in otolaryngology practice in a community.MethodsA prospective randomized blinded trial was conducted on 148 thyroid nodules in 107 patients undergoing ultrasound-guided fine-needle biopsy. Needle gauge was randomized to individual nodule. Patients were blinded to the needle size used. All specimens were assessed via the Bethesda System for Reporting Thyroid Cytopathology and assigned a morphologic quantitative score based on number of thyroid cells and lymphocytes, amount of colloid, and degree of blood/fibrin artifact in each sample. Patient pain experience was scored. A chi-square test was used to compare nondiagnostic rates, and differences in cytologic morphology and pain scores were compared with 2-sample Student t tests.ResultsOf the 148 nodules, 77 were biopsied with 25G needles and 71 with 27G needles. Twenty-five percent (19/77) of the samples obtained with 25G needles yielded a nondiagnostic cytology result (Bethesda category 1) as compared with 11% (8/70) in the 27G group (P = .0282; 95% CI, 1.47%-25.97%). On average, samples from 25G needles had a higher blood/fibrin quantitative score (P = .043; 95% CI, −0.64 to −0.010). There were no differences in pain between groups.ConclusionUse of a 27G needle for fine-needle biopsies is not only safe and feasible but desirable and highly recommended, as it yields better diagnostic information.

Intraarterial catheter diameter and dynamic response of arterial pressure monitoring system: a randomized controlled trial.

The dynamic response (DR) of the arterial pressure monitoring system (APMS) may depend on the intraarterial catheter (IAC) diameter. We hypothesized that adequate DR would be more common when using a smaller IAC. We compared the DR of the AMPS (Auto Transducer™) between three IACs (BD Angiocath Plus™) with different diameters. 353 neurosurgical patients were randomized into three groups undergoing catheterization with a 20-, 22-, or 24-gauge IAC: 20G (n = 119), 22G (n = 117), and 24G (n = 117) groups, respectively. The DR, which depends on the natural frequency and damping coefficient, was divided into four types: adequate (primary outcome measure), underdamped, overdamped, and unacceptable. The frequency of intraoperative IAC malfunction was noted. Adequate DR was observed more frequently in the 22G and 24G groups than the 20G group (13.7% and 15.4% vs. 4.2%, P = 0.011 and 0.004, respectively). The frequency of underdamped DR was higher in the 20G group than the 24G group (86.6% vs. 69.2%, P = 0.001), whereas overdamped DR was more frequent in the 24G group than the 20G and 22G groups (6.0% vs. 0.0% and 0.0%, P = 0.007 and 0.014, respectively). IAC malfunctioned more frequently during surgery in the 24G group than the 20G and 22G groups (15.4% vs. 0.0% and 1.7%, P < 0.001 and P < 0.001, respectively). The frequency of adequate DR was low regardless of the IAC diameter. Nonetheless, in terms of DR and IAC malfunction, a 22-gauge BD Angiocath Plus™ was more suitable for invasive blood pressure monitoring with Auto Transducer™ than a 20- or 24-gauge BD Angiocath Plus™. Registration Registry: ClinicalTrials.gov. Registration number: NCT03642756. Date of Registration: July 27, 2018.

Intraocular Pressure Change and Sustained Intraocular Pressure Elevation After Pars Plana Vitrectomy.

Objectives:The aim of this study was to investigate the incidence and influential factors of changes in intraocular pressure (IOP) and sustained IOP elevation (SIOPE) after an uncomplicated pars plana vitrectomy (PPV).Methods:In all, 41 eyes of 41 patients who underwent PPV due to the presence of epiretinal membrane, macular hole, or vitreomacular traction syndrome were included in the study. In the vitrectomized eye, an elevated IOP of ≥21 mmHg or an increase of ≥6 mmHg from the preoperative IOP on 2 or more postprocedure visits or the addition of a new IOP-lowering medication during follow-up was defined as sustained IOP elevation. The results of procedures performed with a 20-G instrument and a 23-G instrument were compared.Results:The mean postoperative IOP was significantly higher than the preoperative IOP in vitrectomized eyes (preoperative IOP: 15.2±3.1 mmHg; postoperative 1st month: 17.4±5.8 mmHg, p=0.018; 6th month: 17.3±2.6 mmHg, p=0.02; 12th month: 16.7±2.6 mmHg, p=0.020). While no significant difference in IOP was detected between the vitrectomized and fellow eyes preoperatively, the IOP was significantly higher in the vitrectomized eyes in the 1st, 6th, and 12th months (p=0.040, p <0.001, p <0.001, respectively). SIOPE was detected in 15 vitrectomized eyes (37%) and 1 fellow eye (2%). The postoperative first day IOP was significantly lower in the vitrectomized eyes (11.1±6.1 vs 15.4±2mmHg; p<0.001) and significantly lower in the 23-G group than the 20-G group (9.3±5.2 vs 15.7±5.8; p=0.001).Conclusion:IOP may rise significantly in comparison with the fellow eye or the preoperative IOP, even after an uncomplicated PPV. SIOPE and preoperative IOP values should be taken into consideration in addition to cross-sectional IOP findings in the evaluation of PPV.

25 vs. 27-gauge micro-incision vitrectomy surgery for visually significant macular membranes and full-thickness macular holes: a retrospective study

BackgroundTo evaluate visual and safety outcomes for 25-gauge (25G) and 27-gauge (27G) micro-incision vitrectomy platforms (MIVS) for the treatment of epiretinal membrane and full-thickness macular holes.MethodsRetrospective analysis of all patients who underwent internal limiting membrane (ILM) peel surgery from January 2017 through December 2018. 207 cases met the eligibility criteria for inclusion. Primary endpoint was post-operative Best-Corrected Distance Visual Acuity (BCVA) at 6 months.ResultsFor all patients combined, mean logMAR BCVA improved from 0.57 (± 0.40) to 0.37 (± 0.36) post-operatively (p < 0.001). For 25G ERMs, logMAR BCVA improved from 0.51 (± 0.28) to 0.30 (± 0.25) post-operatively (p < 0.001). For 27G ERMs, logMAR BCVA improved from 0.33 (± 0.28) to 0.28 (± 0.27) post- operatively (p = 0.15). For 25G FTMHs, logMAR BCVA improved from 0.87 (± 0.48) to 0.51 (± 0.44) post-operatively (p < 0.001). For 27G FTMHs, logMAR BCVA changed from 0.89 (± 0.47) to 0.96 (± 0.60).ConclusionFinal visual outcomes improved for both 25G and 27G ERM groups and the 25G FTMH group. Both 25G and 27G were safe and well tolerated MIVS platforms for the treatment of ERM and FTMH.

Endoscopic Ultrasound-guided Sampling of Solid Pancreatic Lesions: A Comparative Analysis of 25 Gauge Versus 22 Gauge Core Biopsy Needles.

Pancreatic mass sampling has historically been performed by endoscopic ultrasound-guided fine needle aspiration (EUS-FNA). However, its sensitivity has been reported to be within a wide range, which limits its reliability. Fine needle biopsy (FNB) has been shown to have superior diagnostic performance and is increasingly replacing fine needle aspiration. In FNA, 25 gauge (G) needles appear to outperform 22G. Data comparing these sizes in FNB platforms is limited. We aimed to prospectively compare the performance of 22G and 25G Franseen-tip core biopsy needles in the sampling of solid pancreatic lesions. Patients who underwent EUS-FNB of pancreatic lesions at the Indiana University Hospital using 2 needle sizes: 25G (Study group) and 22G (Control group) using the Acquire needle (Boston Scientific Co., Natick, MA, USA) were enrolled. Needle choice was left to the discretion of the endosonographer. Tissue specimens were evaluated onsite, and underwent touch and smear and cellblock preparation. Specimens were independently evaluated by 2 expert cytopathologists blinded to diagnosis. Cytopathologists assessed cytological yield (on smears) and histological yield (on cellblock) using a validated scoring system reached by a consensus among our cytopathologists as we have previously published. A total of 75 patients (42 males, median=65 years) underwent EUS-FNB during the study period (2017-2018): 50 using 25G and 25 using 22G needle. Diagnostic yield was numerically higher in 25G (98% vs. 88%, p=0.105). Number of passes for smears were similar, however the 25G group required additional passes for cell-block (1.6 vs. 0.4, p=0.001). 25G was used more frequently for pancreatic head and uncinate process sampling (70% vs. 52%, p=0.126). Four patients had self-limited adverse events in the 22G group, but none in the 25G group. We report no difference in the diagnostic yield between 25G FNB vs. 22G sampling device with Franseen style tip, however, the 25G needle use was associated with the need of additional passes to collect a sufficient cell block.

Comparison of 27-Gauge and 25-Gauge Microincision Vitrectomy Surgery for the Treatment of Vitreoretinal Disease: A Systematic Review and Meta-Analysis.

Background We performed a systematic review and meta-analysis to evaluate the safety and effectiveness of 27-gauge (27-G) microincision vitrectomy surgery (MIVS) compared with 25-guage (25-G) MIVS for the treatment of vitreoretinal disease. Methods A systematic electronic search was conducted in March 2020 in PubMed, Embase, and the Cochrane library. Eligible criteria for including studies were controlled trials comparing 27-G vitrectomy with 25-G vitrectomy in patients with vitreoretinal disease. The main outcomes included operation time; best corrected visual acuity (BCVA) in logMAR; postoperative intraocular pressure (IOP); primary anatomical success rate for rhegmatogenous retinal detachment (RRD) cases and postoperative central macular thickness (CMT) for idiopathic epiretinal membrane (ERM) cases; intraoperative/postoperative complications. Odds ratio (OR) and mean difference (MD) were synthesized under fixed or random effects models. Results Eleven studies enrolling 940 eyes were identified. Among those 11 studies, six studies were on the treatment of RRD and five studies were on the treatment of ERM, so subgroup analyses were conducted. The total pooled results indicated that 27-G surgery system had obvious advantages in improving BCVA at six months after the vitrectomy (P = 0.004) and reducing intraoperative/postoperative complications (P = 0.03). However, the mean operation time was significantly longer by three minutes for 27-G compared with 25-G vitrectomy (P = 0.002). In subgroup analyses, for the treatment of ERM cases, 27-G group was associated with less complications and longer operation time. However, for the treatment of RRD cases, 27-G groups and 25-G groups were comparable in operation time, postoperative BCVA, postoperative IOP, and primary anatomical success rate. Conclusions This meta-analysis confirmed that 27-G MIVS was an effective and safe surgical system compared with 25-G MIVS for the treatment of RRD and ERM cases, even though 27-G system needs a longer surgical time.

Frequency of Post-Operative Hypotony in 23 Gauge and 25 Gauge Pars Plana Vitrectomy in Advanced Diabetic Eye Disease

Purpose: To compare the frequency of post-operative hypotony between 23G PPV and 25G PPV in advanced diabetic eye disease.&#x0D; Study Design: Quasi experimental study.&#x0D; Place and Duration of Study: Study was conducted at department of Ophthalmology, Lahore General Hospital, Lahore from 7th April 2016 to 6th October 2016.&#x0D; Methods: Total 100 cases of advanced diabetic eye disease with age ranging from 25 – 65 years and either gender were selected. Patients with nystagmus and claustrophobia, lamellar macular holes, epiretinal membrane and neovascular glaucoma were excluded. Patients were divided by lottery method into 2 groups. Data of the patient i.e. name, age, sex, patient’s registration number and address was recorded. Every patient had detailed preoperative work-up; including best corrected visual acuity by Snellen’s chart, intraocular pressure by applanation tonometer, indirect ophthalmoscopy and B-scan for retinal status. Group A underwent 23G PPV and group B underwent 25G PPV. Patients were followed after 24 hours of surgery to measure intraocular pressure to access hypotony.&#x0D; Results: Mean age of patients in group A was 50.16 ± 10.40 years and in group B was 50.26 ± 9.91 years. Out of 100 patients 57 (57.0%) were females and 43 (43.0%) were males, with female to male ratio of 1.1:1. Post-operative hypotony was seen in 24 (48.0%) patients with 23G PPV and 02 (4.0%) patients with 25G PPV (p-value = 0.0001).&#x0D; Conclusion: This study concluded that the frequency of post-operative hypotony in 23G Pars Plana Vitrectomy was higher as compared to 25G Pars Plana Vitrectomy in advanced diabetic eye disease.&#x0D; Key Words: Diabetic retinopathy, Pars Plana Vitrectomy, Hypotony.

Comparative assessment of barium tagging options for residual colonic contents at virtual colonoscopy

Objective: to compare the quality of residual colonic content tagging with 25 and 50 g of BAR-VIPS, the basе of which is barium sulfate (BaSO4), in preparing patients for virtual colonoscopy (VСS) and to evaluate the diagnostic efficiency of the method in both cases.Material and methods. The paper presents the results of VCS in 100 patients divided into two groups containing equal numbers (n = 50) according to the contrast medium dose (25 and 50 g). In each group, the quality of fecal tagging (FT) was compared by its presence and degree and by the presence and completeness of high-density artifacts for residual liquid and solid fragments separately. The reliability of the results of VCS versus fibrocolonoscopy was assessed in detecting additional colon tumors of three sizes (&lt;6, 6-9, and ≥10 mm) in each group of patients. These results were used to calculate the diagnostic efficiency of VCS in each group.Results. The investigation showed significantly lower FT quality indicators in the patients using 25 g of BAR-VIPS than in those having 50 g of the same agent (p = 0.00001). Naturally to the quality of FT, all VCS information capability indices for all sizes of colonic tumors were lower in the 25-g group than those in 50g group.Conclusion. The option of preparing patients for VCS using residual colonic content tagging with 50 g of barium-containing BAR-VIPS has been found to have a significant advantage over that using 2 g of the same agent. This is shown in the better quality of FT and in the higher diagnostic efficiency of the method.

Comparison of 27-gauge versus 25-gauge vitrectomy results in patients with epiretinal membrane: 6-month follow-up

PurposeTo compare the 27G versus 25G vitrectomy in patients with epiretinal membrane (ERM).Patients and methodsSixty pseudophakic eyes of 60 consecutive patients treated by pars plana vitrectomy (PPV) using 27G (30 eyes) or 25G (30 eyes) were prospectively evaluated including eye’s inflammation, surgery time, ERM + ILM removal time and complications. Additionally, 1, 3, 7, 14, 30, 90 and 180 days after PPV, the following were estimated: intraocular pressure (IOP), sclerotomy wound closure time, distance best corrected visual acuity (DBCVA), foveal macular thickness (FMT) and surgically induced astigmatism (SIA).ResultsThe eye’s inflammation resolved within 30 days after surgery in both groups. The surgery and ERM + ILM times were longer in the 27G group (p ≤ 0.02). The most common postoperative complication was hypotony in both groups, more common in 25G group (23.3% vs. 10% of eyes). In 27G group, the mean IOP prior to 180 days postoperatively was higher (p < 0.05) and the sclerotomy wound closure time was shorter (p < 0.001). Mean DBCVA values (7, 14, 30 days after surgery) were significantly better in 27G group (p < 0.001). The mean FMT values were similarly and significantly reduced in both groups 1 day postoperatively (p < 0.05) as compared to preoperative values and then stabilized during follow-up. Mean SIA was lower in 27G group 30, 90 and 180 days after surgery (p < 0.001).ConclusionThe use of 27G PPV in patients with ERM significantly reduced sclerotomy wound closure time and surgically induced astigmatism, better stabilized intraocular pressure and allowed to achieve faster visual acuity improvement, as compared to 25G PPV.

893 Endoscopic Ultrasound-Guided Sampling of Solid Pancreatic Lesions: A Comparative Analysis of 25 vs. 22 Gauge Core Biopsy Needles

INTRODUCTION: Endoscopic ultrasound guided fine needle biopsy (EUS-FNB) is increasingly replacing fine needle aspiration (FNA) for sampling of solid pancreatic lesions. In FNA, 25G needles appear to outperform 22G needles in sampling pancreatic lesions, but data comparing 22G and 25G FNB platforms is lacking. We aimed to prospectively assess the performance of 22G and 25G Franseen tip core biopsy needles in the sampling of solid pancreatic lesions. METHODS: Consecutive patients were enrolled between 2017 and 2018 and underwent EUS-FNB sampling of solid pancreatic lesions at Indiana University Hospital using 2 needle sizes: 25G (Study group) and 22G (Control group) Acquire needles (Boston Scientific Co., Natick, MA, USA). The endosonographer chose the needle size based on lesion location and characteristics. Tissue specimens were handled in a standardized fashion using onsite evaluation, touch and smear preparation, and cell block tissue collection. Specimens were independently evaluated by 2 expert cytopathologists blinded to the diagnosis in each case. They assessed cytological yield (on smears) and histologic yield (on cellblock) using a previously validated standard scoring system reached by a consensus among our cytopathologists. RESULTS: A total of 75 patients (42 males, median age = 65 years) with solid pancreatic lesions underwent EUS-FNB during the study period: 50 using a 25G and 25 using 22G needle. There was no significant difference in the size or final cytopathological diagnosis of the lesions between the 2 groups (Table 1). Similarly, cytological scores of smears were comparable between the 2 groups. Due to the 25G needle’s increased flexibility in locations that entailed excessive scope angulation, it was utilized more for lesion sampling in the pancreatic head and uncinate process (70% vs 52%, P = 0.012). There was a statistically significant increase in diagnostic yield seen in the 25G group compared to the 22G (98% vs 88%. P = 0.013). The number of passes for cytological smears between both groups were similar; however, the 25G group required additional passes to obtain an adequate cell-block (1.6 vs 0.4, P = 0.001). CONCLUSION: We found the 25G FNB needle to be associated with superior diagnostic adequacy over 22G needles. This is consistent with FNA literature comparing these two common needle sizes. We noted an increased number of passes required in the 25G group to develop a cell block. This is likely due to the smaller size needle requiring more passes to build up an adequate cell block.