25-gauge System Research Articles

Primäre 25- und 23-Gauge-Vitrektomie in der Behandlung der rhegmatogenen Netzhautablösung – sinnvolle Ergänzung oder Schritt in die falsche Richtung?

Pars plana vitrectomy techniques with 25- and 23-gauge transconjunctival systems are rapidly growing in popularity. These systems were mainly used in the treatment of macular diseases. However, an expansion to more complicated vitreoretinal procedures including the treatment of rhegmatogenous retinal detachments can currently be observed. In this review, the results and complications of 25- and 23-gauge vitrectomy techniques are analysed. A review has been made of the current literature concerning 25- and 23-gauge vitrectomy techniques with particular attention to the treatment of rhegmatogenous retinal detachments. The benefits of 25-gauge and 23-gauge vitrectomy (shorter operating times, decreased inflammation of the anterior segment, increased patient comfort and enhanced visual recovery) are of no clinical significance when treating rhegmatogenous retinal detachments and do not seem to offer an advantage over 20-gauge vitrectomy or scleral buckling techniques. Recently published series with primary anatomic reattachment rates between 71% and 93% and a mean postoperative visual acuity of 20/50 seem to suggest a worsening of the treatment results with these new techniques. In addition, 25-gauge and 23-gauge techniques are technically challenging, associated with significant complications (for example, postoperative hypotony) and increase the risk for exogenous endophthalmitis. New 25-gauge and 23-gauge vitrectomy techniques for rhegmatogenous retinal detachment show no advantage over scleral buckling techniques in phakic patients or 20-gauge vitrectomy in pseudophakic patients. Moreover, these techniques seem to worsen the outcome and increase the postoperative complication rate.

TRANSCONJUNCTIVAL 25-GAUGE SUTURELESS VITRECTOMY AND SILICONE OIL INJECTION IN DIABETIC TRACTIONAL RETINAL DETACHMENT

The purpose of this article was to evaluate the outcomes and complications of transconjunctival sutureless 25-gauge vitrectomy using silicone oil tamponade in diabetic tractional retinal detachment. Patients were retrospectively evaluated. Main outcome measure was the feasibility of pars plana vitrectomy and silicone oil injection with 25-gauge system in eyes with diabetic tractional retinal detachment. Fourteen eyes of 14 patients were included in the study. Tractional retinal detachment was accompanied by vitreous hemorrhage in 9 eyes and combined traction/rhegmatogenous retinal detachment was present in 1 eye. All patients underwent transconjunctival sutureless 25-gauge vitrectomy and 1,000 centistokes silicone oil injection. Angled insertion of the trocars was made in all eyes. Bimanual surgery was performed in 6 (42.8%) eyes. The median preoperative best-corrected visual acuities were 3.00 logarithm of the minimum angle of resolution; it increased to 1.60 logarithm of the minimum angle of resolution at last visit. Retinal tear formation occurred in 4 (28.5%) eyes. Retinal detachment developed in 2 (14.2%) eyes. Intraocular pressure of 5 mmHg or less was detected in 3 (21.4%) eyes. One patient lost light perception due to anterior hyaloidal fibrovascular proliferation. Pars plana vitrectomy and 1,000 centistokes silicone oil injection with 25-gauge system is feasible in diabetic tractional retinal detachment even in complex cases. Indications of 25-gauge surgery may be expanded toward this area.

23-GAUGE VITRECTOMY IN 100 EYES

To report the short-term outcomes and complications of patients undergoing 23-gauge transconjunctival sutureless pars plana vitrectomy. Retrospective, consecutive, noncomparative case series in which 100 eyes of 100 patients underwent elective 23-gauge pars plana vitrectomy for a variety of surgical indications. All patients were examined on postoperative day 1 and then approximately 1 and 4 weeks later. Demographic and ophthalmic data were recorded. Fifty-two men and 48 women (mean age = 65 years) were observed for a mean of 26 weeks. Mean preoperative visual acuity was 20/842 and mean final postoperative visual acuity was 20/429. Postoperative visual acuity improved in 68% of patients, worsened in 16%, and remained unchanged in 16%. Mean preoperative intraocular pressure was 15 mmHg and mean postoperative intraocular pressure at final visit was 14 mmHg. No sutures were required to close sclerotomies and no intraoperative complications were observed, though one eye required conversion to 20-gauge pars plana vitrectomy during silicone oil removal. Postoperative complications included retinal detachment, cataract progression, vitreous hemorrhage, persistent macular hole, new macular hole, phthisis, posterior capsular opacification, and severe chemosis. Twenty-three-gauge pars plana vitrectomy demonstrates short-term visual outcomes and complication rates that are comparable to those reported with 20- and 25-gauge systems.

Suprachoroidal fluid as a complication of 23-gauge vitreous surgery

The popularity of transconjunctival sutureless vitreoretinal surgery has been increasing recently.1 2 Eckardt designed a 23-gauge instrument system for transconjunctival sutureless vitrectomy.3 Howard et al reported on the effectiveness and...

Iluvien™: a new sustained delivery technology for posterior eye disease

Iluvien™ (fluocinolone acetonide intravitreal insert, Alimera Sciences, Inc.), a novel injectable intravitreal insert, is being studied to deliver a very low dose of a corticosteroid to the retina for up to 3 years as a treatment for diabetic macular edema. Using a proprietary 25-gauge injector system, an ophthalmologist injects the Iluvien insert, which uses the Medidur™ (Alimera Sciences, Inc.) technology, into the vitreous through a minimally invasive procedure in an out-patient setting. The placement of the device in the inferior vitreous has the potential to maximize drug at the retina while reducing exposure of the anterior chamber. Phase III studies are underway to test the safety and efficacy of Iluvien. This article offers a specific review of the Iluvien technology rather than an overview of the various intravitreal methods of treating posterior eye disease.

23-gauge versus 20-gauge system for pars plana vitrectomy: a prospective randomised clinical trial

Aim:To compare the sutureless 23-gauge system with a standard 20-gauge system in pars plana vitrectomy.Methods:60 patients in two randomised groups were included in this prospective clinical trial. Pars plana vitrectomy...

23-gauge sutureless vitrectomy and 20-gauge vitrectomy: a case series comparison

To directly compare the per-operative safety and efficacy of the 20- and 23-gauge vitrectomy systems as well as day 1 intraocular pressure (IOP). Data were collected on 50 consecutive vitrectomy cases performed using the 20-gauge system and 23-gauge sutureless vitrectomy. All surgeries were carried out by one surgeon (RLB) at a single centre. Data collected prospectively included indication for surgery, iatrogenic retinal tears, and operating times. Most common indications for surgery were macular hole, rhegmatogenous retinal detachment, diabetic vitreous haemorrhage (no tractional retinal detachment), and macular pucker. Intraocular tamponade with air, sulphur hexafluoride (SF6), hexafluoroethane (C2F6) or octafluoropropane (C3F8), or silicone oil was used in 25 patients in the 20-gauge group and 46 patients in the 23-gauge group. One scleral port required suture in patients who underwent 23-gauge vitrectomy (0.67%). Every 20-gauge patient had all the three ports sutured. The mean first day IOP was 22.88 mm Hg in the 20-gauge vs 17.58 mm Hg in the 23-gauge (P<0.001). Four patients in the 20-gauge group had an IOP >40 mm Hg compared to none in the 23-gauge group. In contrast, four patients had postoperative hypotony in the 23-gauge group compared to none in the 20-gauge group. The mean operating time for all the 50 cases in each group was 39.4 (20 gauge) vs 29 min (23 gauge) P<0.001. Our study indicates less risk of considerably raised IOPs and reduced surgical operating time with the 23-gauge system. Additional advantages observed included faster wound healing, diminished conjunctival scarring, improved patient comfort, and decreased postoperative inflammation.

The incidence of endophthalmitis following transconjunctival sutureless 25- vs 20-gauge vitrectomy

To determine the incidence of endophthalmitis following 25-gauge and standard 20-gauge vitrectomy. In this single-centre retrospective interventional case series, we evaluated the incidence of acute endophthalmitis occurring within the 14-day postoperative period in all patients who underwent pars plana vitrectomy between 1 November 2002 and 31 December 2006. A total of 3477 consecutive patients were identified. Of them, 3046 patients underwent 20-gauge vitrectomy and 431 underwent 25-gauge vitrectomy. The event rates of postoperative endophthalmitis were 0.03% (1 of 3046) after 20-gauge vitrectomy and 0.23% (1 of 431) after 25-gauge vitrectomy (P=0.23). In the endophthalmitis case that occurred after 25-gauge vitrectomy, a combined phacoemulsification cataract surgery was performed with the 25-gauge vitrectomy. Analyses of event rates of postoperative endophthalmitis after combining phacoemulsification cataract surgery and vitrectomy were 0% (0 of 170) for 20-gauge vitrectomy and 2.17% (1 of 46) for 25-gauge surgery vitrectomy (P=0.21). The incidence of postoperative endophthalmitis following 25-gauge vitrectomy and 20-gauge surgery is low. Although there is a trend suggesting an increased risk of endophthalmitis with the 25-gauge system, this difference was not statistically significant given the low number of measured outcomes.

Vitrectomie transconjonctivale 25 Gauge : à propos de 110 yeux opérés

To evaluate the safety and efficacy of the 25-gauge transconjunctival vitrectomy system for a variety of vitreoretinal surgery indications at short-term follow-up. Retrospective study of consecutive interventional cases that underwent surgery performed by one surgeon using the Alcon 25-Gauge vitrectomy system, in Bordeaux University Hospital, from September 2004 to May 2006. Indications were epiretinal macular membrane (72 eyes), macular hole (24 eyes), and other diseases (14 eyes). One hundred and ten eyes of 105 consecutive patients underwent surgery. None required conversion to 20-gauge vitrectomy or wound suture. One iatrogenic retinal break occurred intraoperatively. Two transient wound leaks, seven cases of hypotonia, one of chronic endophthalmitis, one of rhegmatogenous retinal detachment, one of retinal break, two recurrent intravitreal hemorrhages, and six cases of hypertonia were noted postoperatively. Three eyes required additional surgery. Mean overall visual acuity improved from 0.691 +/- 0.465 logMAR preoperatively to 0.476 +/- 0.492 logMAR at 1 month (p<0.0001). Visual acuity improvement was statistically significant for eyes with macular epiretinal membrane (p<0.0001) and macular hole (p=0.0158). The macular hole closure rate was 87.5%. Mean operative time was 25.91+/-10.94 min. Mean follow-up was 13.32+/-18.1 weeks. Thirteen eyes developed cataracts during the follow-up period. Vitrectomy with the 25-Gauge system appears to be relatively safe and particularly appropriate for macular surgery.

Repair of Primary Rhegmatogenous Retinal Detachment Using 25-Gauge Transconjunctival Sutureless Vitrectomy

: To evaluate the anatomical and visual outcomes of primary rhegmatogenous retinal detachment repairs performed using 25-gauge transconjunctival sutureless vitrectomy. : A retrospective, noncomparative interventional case series including 53 consecutive eyes of 52 patients who underwent 25-gauge transconjunctival sutureless vitrectomy to repair primary rhegmatogenous retinal detachment was performed. Variables collected for the study were patient demographics, lens status, preoperative visual acuity, and macular status. Outcome measures included single-operation anatomical success rate, final anatomical success rate, postoperative visual acuity, and surgical complications. : The retina was reattached with a single operation in 39 (74%) of 53 eyes. The final anatomical success rate was 100%. The mean time to redetachment was 72 days (range, 13-334 days). Proliferative vitreoretinopathy (64%) and development of new retinal breaks (43%) were the most common reasons associated with redetachment. Mean visual acuity improved from 20/100 to 20/60 (P = 0.001); 55% of eyes had final vision of 20/40 or better. Three eyes (6%) developed postoperative choroidal hemorrhage. Three eyes (6%) developed visually significant macular pucker that required surgery. No postoperative hypotony or endophthalmitis was observed. : Repair of primary rhegmatogenous retinal detachments using 25-gauge transconjunctival sutureless vitrectomy resulted in excellent final anatomical success rate and postoperative visual outcomes. However, redetachments due to new tears and/or proliferative vitreoretinopathy resulted in a lower single-operation success rate than those reported with 20-gauge systems.

Clinical Utility of Endoscopic Ultrasound-Guided Fine Needle Aspiration in Pancreatic Masses Using a 25-Gauge Needle System: A Multicenter Experience

Background and Aims: EUS-FNA is now performed routinely in many advanced endoscopy centers and has enhanced the ability to diagnose pancreatic masses. However, there is uncertainty about which needle size is most optimal for EUS-FNA of pancreatic masses. All of the early published data on this topic is based on the use of 22-gauge or 19-gauge EUS-FNA needles. It is postulated that a smaller caliber needle might provide more accurate results and have less complications. We aimed to evaluate our experience in diagnosing pancreatic masses with EUS-FNA using a 25-gauge disposable needle system. Methods: All patients referred for EUS-FNA for pancreatic masses between Feb 2001 and Nov 2007 at three advanced endoscopy centers were reviewed and patients who underwent EUS-FNA using the 25-gauge needle system (EchoTip, Cook Endoscopy, Winton-Salem, NC) were identified. In this IRB exempt study data related to patient demographics, clinical findings, long term follow-up and pathological findings were recorded. In patients who underwent surgery, operative histopathology was compared with the cytopathology from EUS-FNA. Results: A total of 288 patients (mean age 65y, age range 18-91y; 150 M, 138 F) with pancreatic masses detected on CT and/or MRI and confirmed by EUS underwent EUS-FNA with the 25-gauge needle. Adequate samples were obtained in 94% (271/288) of the patients. Pancreatic malignancy was diagnosed on cytopathology in 56% (161/288) and no malignancy was identified in 38% (110/288) of the patients. EUS-FNA sample was inconclusive in 6% (17/28). No complications were reported in our study cohort. Of patients with pancreatic malignancy, 89% (144/161) had adenocarcinoma, while 11% (17/161) had other malignancies. Surgical pathology was available and compared to the EUS-FNA cytopathology in 26 patients. Inconclusive results were considered negative for comparison. There were no false-positive results and 3 false-negative FNA results (1 negative, 2 inconclusive). Sensitivity, specificity, PPV and NPV of FNA were 81%, 100%, 100% and 78% respectively. Conclusions: EUS-FNA with a 25-gauge needle system is a safe and reliable method for tissue sampling in pancreatic masses. There were no complications noted in our study. When compared to previously published studies, there is an expected complication rate of ∼2% with pancreatitis being the most concerning. Our study suggests that perhaps the smaller caliber 25-gauge needle causes less trauma during EUS-FNA and hence less complications. Further studies including randomized trials are needed to determine the comparative accuracy and safety of the 25-gauge needle system against other available needles.

Fluid dynamics in three 25‐gauge vitrectomy systems: principles for use in vitreoretinal surgery

To compare infusion and extrusion fluid volumes with three 25-gauge vitrectomy systems. The infusion and aspiration rates of 25-gauge systems from Alcon (Fort Worth, TX, USA), Bausch & Lomb (St Louis, MO, USA), and the Dutch Ophthalmic Research Centre (DORC, Zuidland, the Netherlands) were measured in vitro using balanced saline solution with different heights (40, 60, 80, 100, 120 cm) of infusion bottle, cutter velocities (800, 1100, 1500 cuts/ min) and aspiration powers (100, 200, 300, 400, 500 mmHg). The infusion flow velocities differed among the systems (p < 0.001 for all comparisons [p-values 0.0009-0.0001]). The aspiration rates of the Alcon and Bausch & Lomb systems were lower than that of the DORC system (p < 0.02 for all comparisons [p-values 0.018-0.002]). Infusion and extrusion fluid rates differ among 25-gauge vitrectomy systems. These results may help to optimize ideal aspiration and infusion parameters among 25-gauge vitrectomy systems used to treat vitreoretinal diseases.

Passive removal of silicone oil with a 25-gauge sutureless system

To report the outcome of a new sutureless technique for passive removal of silicone oil with a 25-gauge system. Between January 2005 and February 2006, 32 patients (32 eyes) underwent passive silicone oil removal with a 25-gauge system in a prospective, interventional case series in our hospital. Main data recorded were visual acuity, intraocular pressure (IOP), silicone oil removal time, complications, and number of sutured sites. Mean follow-up was 11.46 +/- 3.98 months. Mean silicone oil removal time was 8.93 +/- 0.85 (range, 7.0-11.5) min. A suture was placed in only one eye because of leakage. Visual acuity improved in 27 eyes (86.4%), and stabilized in five eyes (15.6%). IOP decreased significantly at all visits during follow-up. On day one, four eyes (12.5%) were hypotonous. Choroidal folds were observed in two eyes (6.25%). No other complications were noted. Passive removal of silicone oil with a 25-gauge sutureless technique was effective for 1000 centistokes of oil. Transient hypotony in the early postoperative period did not adversely affect the visual outcomes.

VISUAL OUTCOMES WITH 23-GAUGE TRANSCONJUNCTIVAL SUTURELESS VITRECTOMY

To evaluate the outcomes of patients treated with 23-gauge transconjunctival sutureless vitrectomy for various posterior segment conditions. A retrospective chart review of 81 consecutive 23-gauge vitrectomy cases done by a single vitreoretinal surgeon for various posterior segment conditions was done. All surgery was performed using the two-step 23-gauge system developed by Dutch Ophthalmic Research Center. All patients had at least 3-month follow-up. Main outcome measures included visual acuity, intraocular pressure, and operative complications. Mean follow-up was 6.5 months (range 3-9 months). Mean overall preoperative visual acuity was 20/150 and final acuity was 20/70 (P < 0.0001). Mean intraocular pressure on postoperative day 1 was 14 mmHg (range 6-28 mmHg). There was a single case of intraoperative retinal tear that required treatment with cryotherapy. Twenty eyes of 48 phakic eyes (42%) had worsening of cataracts in the postoperative period. There were no postoperative complications of endophthalmitis or retinal detachment. Twenty-three-gauge transconjunctival sutureless vitrectomy is an effective surgical technique in the management of vitreoretinal diseases. Complications were rare and compared favorably with published literature on 20-gauge and 25-gauge surgery.

Comparison of Silicone Oil Removal Using 23-Gauge and 20-Gauge System for Pars Plana Vitrectomy

Purpose: The purpose of this study was to compare the clinical results of silicone oil removal using a 23-gauge transconjunctival sutureless pars plana vitrectomy (TSVS) and the 20-gauge pars plana vitrectomy (PPV) system and to evaluate the clinical value of 23-guage PPV system in silicone oil removal. Methods: Eight eyes of 8 patients who received removal of silicone oil using the 23-gauge TSVS and 6 eyes of 6 patients using the 20-gauge PPV system were included in this study. The total operation time, silicone oil removal time, intraoperative and postoperative advantages, shortcomings, and complications were compared. Results: The operation time and silicone oil removal time were 44.6±14.1 minutes, 42.7±10.5 minutes and 2.0±0.9 min/cc, 1.4±0.6 min/cc when silicone oil removal was performed using 23-gauge TSVS and 20-gauge PPV system, respectively. They were not significantly different (p=0.80, 0.22). Attention for the complete removal of the oil is necessary because of the intraocular trocar length when the 23-gauge TSVS is used. There were no complications except transient hypotonies (2 eyes), transient hypertonies (2 eyes) in the 23-gauge system and transient hypertonies (2 eyes) in the 20-gauge system. Conclusions: The operation time for silicone oil removal using the 23-gauge TSVS was not different than that of the 20-gauge PPV system and can be performed safely without any particular complications. Care and precautionary measures are needed in order to remove silicone oil completely.

Transconjunctival sutureless 23-gauge vitrectomy for vitreoretinal diseases: Outcome of 30 consecutive cases

Background:To describe the initial experience, effectiveness, and safety profile of 23-gauge instrumentation for a variety of vitreoretinal conditions.Methods:A retrospective review of 30 consecutive 23-gauge vitrectomy cases done by a single vitreoretinal surgeon for various posterior segment conditions was done. All surgeries were performed using the two-step 23-gauge system developed by Dutch Ophthalmic Research Center (DORC). All patients had at least 3-month follow-up. Main outcome measures included surgical success, visual acuity, intraocular pressure, and operative complications.Results:Mean follow-up was 7.7 months (range 3–12 months). Indications for surgery included rhegmatogenous retinal detachment (n=8), nonclearing vitreous hemorrhage (n=6), tractional retinal detachment (n=5), macular hole (n=5), epiretinal membrane (n=3), retained lens fragments (n=2) and endophthalmitis (n=1). Gas tamponade was used in 18 eyes (60%) and silicone oil in six eyes (20%). Mean overall preoperative visual acuity was 20/1053 and final acuity was 20/78 (P = 0.001). Mean intraocular pressure after 6 hours was 15.1mmHg (range 4-25 mmHg) and on postoperative day one was 14.5 mmHg (range 2-21 mmHg). Four eyes (13.3%) required suturing of sclerotomy intraoperatively. Conversion to 20-gauge was done in one eye (3.3%). Hypotony was reported in one eye (3.3%) postoperatively. Subconjunctival silicone oil reported in one eye (3.3%). There were no postoperative complications of endophthalmitis, retinal or choroidal detachment.Conclusion:23-gauge transconjunctival sutureless vitrectomy was effective in the management of wide variety of vitreoretinal surgical indications. The safety profile compared favorably with published rates for 25-gauge systems.

Vitreous Substitute Removal Rates with the Accurus® and Millennium™ Vitrectomy Systems

Recent innovations in vitrectors have led to studies of evaluated aspiration rates of basic saline solution, porcine vitreous, and human vitreous, but each of these substances has potential drawbacks. The authors determined the timed removal rates of egg white with the Accurus 20-, 23-, and 25-gauge vitreous cutters (Alcon Laboratories, Inc., Fort Worth, TX) and the Millennium AVE 20- and 25-gauge system (Bausch & Lomb, St. Louis, MO and MID Labs, Inc., San Diego, CA) using various machine parameters. The Accurus 20- and 23-gauge cutters and the Millennium AVE 20- and 25-gauge cutters removed egg white easily. At higher cut rates, where slow and delicate removal of vitreous is typically desired, the probes, as expected, removed egg white more slowly.

Neue Entwicklungen in der chirurgischen Therapie der rhegmatogenen Ablatio retinae

The initial surgery is one of the most important factors influencing the anatomic and functional outcome of retinal detachment surgery. With the continual modifications in vitrectomy techniques, the strategy in primary vitrectomy surgery is also changing. Recent developments are the use of 25- and 23-gauge trocar systems and new surgical techniques without the use of perfluorcarbons or gas or silicone oil tamponade. In addition, heavy silicone oils are now entering routine clinical use, especially for proliferative vitreoretinopathy (PVR) redetachments of the lower fundus periphery. Regarding adjunct pharmacologic therapy, daunorubicin and 5-fluorouracil/low molecular weight heparin have been found to improve the results of patients with PVR or at risk for PVR.

Möglichkeiten und Grenzen der innovativen Vitrektomiesysteme

The aim of the present article is to review the methodical and technological development of pars plana vitrectomy. Special attention is drawn to safety, efficiency and functionality of the innovative 25-gauge und 23-gauge vitrectomy systems which are compared to the standard 20-gauge vitrectomy system. This was done based on clinical studies and case reports. A literature search was conducted in a cluster of different medical databases (XMedall; XPharmall). Focus of the research was the "development" and "status quo" of pars plana vitrectomy. In particular, clinical studies and case reports dealing with safety and efficiency of 20-, 23- and 25-gauge vitrectomy systems have been evaluated. Only peer-reviewed articles from 1966 until today were investigated. Finally, a descriptive analysis of the relevant studies was made. Both innovative vitrectomy systems are safe and effective and help to reduce operating time. There was no significant difference in postoperative complications following 25-gauge vitrectomy and 20-gauge vitrectomy. 25-gauge instruments, however, show a greater flexibility. For this reason a certain learning curve is required and the range of application is limited. Due to its greater stiffness and larger diameter, the 23-gauge system - while still allowing a transconjunctival access - may overcome the disadvantages of the 25-gauge system. However, the use of silicone oil may lead to leakage of the sclerotomies and thus necessitate additional suturing. The use of both innovative vitrectomy systems offers the advantage of a faster and less invasive surgical procedure. However, there are disadvantages which limit the indications for 25-gauge vitrectomy. The 23-gauge vitrectomy may overcome these disadvantages and - due to its wider range of application - may be used instead of conventional 20-gauge vitrectomy in most cases. It may therefore become the new standard for vitrectomy.

PERFLUOROCARBON-PERFUSED VITRECTOMY USING A TRANSCONJUNCTIVAL 25-GAUGE SYSTEM

To describe the feasibility of perfluorocarbon-perfused vitrectomy (PCPV) using a 25-gauge system in complicated retinal detachment cases. Thirteen nonconsecutive patients with complicated retinal detachment (either tractional secondary to proliferative diabetic retinopathy or rhegmatogenous) who would not normally be selected for 25-gauge vitrectomy were included in the study. Vitrectomy using 25-gauge ports and perfluorocarbon perfusion was performed. Real vitrectomy time, amount of perfluorocarbon liquid (PCL) used, instrument bending, feasibility of surgical maneuvers using an arbitrary scale, and anatomical and visual results were evaluated. Real vitrectomy time ranged from 6.2 minutes to 17.1 minutes (mean, 10.3 minutes). Amount of PCL ranged from 8 mL to 40 mL (mean, 24.38 mL). Instruments never bent even when using a wide-angle sutured contact lens. All desired maneuvers could be performed and were facilitated by PCL. All retinas were reattached, with two cases of mild recurrent vitreous hemorrhage. Visual acuity improved in 76.9% of eyes. PCPV using a 25-gauge system can be performed, even in complicated cases.