25-, 23-, and 20-gauge vitrectomy in epiretinal membrane surgery: a comparative study of 553 cases

  • Otman Sandali
  • Mohamed El Sanharawi
  • Nicolas Lecuen
  • Pierre-Olivier Barale
  • Sebastien Bonnel
  • Elena Basli
  • Vincent Borderie
  • Laurent Laroche
  • Claire Monin
Retinal Disorders



To compare the safety and functional outcomes of 25-gauge and 23-gauge (G) micro-incision vitrectomy surgery (MIVS) instrumentation with the standard 20-G vitrectomy system in the treatment of epiretinal membranes (ERM).


A retrospective comparative study of 553 consecutive cases with epiretinal membrane who underwent pars plana vitrectomy. Twenty-gauge, 25-gauge and 23-gauge vitrectomy was performed respectively in 347, 91, and 115 eyes. Surgery duration, visual acuity improvement, intraocular pressure variation, intraoperative and postoperative complications were analyzed.


The mean surgical time in the 23-G group and in the 25-G group was shorter than in the 20-G group (P < 0.001). Visual improvement was higher 8 days postoperatively in the 25-G group than in the 20-G and 23-G groups (P = 0.035), but not at 6 weeks postoperatively (P = 0.186). In the 20-G group, the IOP increased significantly on the first day postoperatively (P < 0.001), while in the 23-G group, the IOP decreased on the first day postoperatively (P = 0.073). In the 25-G group, the IOP did not change significantly (P = 0.807). The incidence of complications was not statistically significant between the three groups. Retinal breaks were significantly related to the induction of posterior vitreous detachment, independent of the system gauge.


In ERM surgery, 23-G and 25-G (MIVS) systems are as safe and effective as the 20-G system, and significantly reduce surgical time. Although the 25-G system provides an earlier visual improvement, the 23- and 25- gauge systems are comparable, and the selection will depend on the surgeon’s preference.


20-gauge 23-gauge 25-gauge Vitrectomy Epiretinal membrane Visual improvement Complication 


  1. 1.
    Chen JC (1996) Sutureless pars plana vitrectomy through self-sealing sclerotomies. Arch Ophthalmol 114:1273–1275PubMedCrossRefGoogle Scholar
  2. 2.
    Fujii GY, De Juan E Jr, Humayun MS, Pieramici DJ, Chang TS, Awh C, Ng E, Barnes A, Wu SL, Sommerville DN (2002) A new 25-gauge instrument system for transconjunctival sutureless vitrectomy surgery. Ophthalmology 109:1807–1812, discussion 1813PubMedCrossRefGoogle Scholar
  3. 3.
    Fujii GY, De Juan E, Jr HMS, Chang TS, Pieramici DJ, Barnes A, Kent D (2002) Initial experience using the transconjunctival sutureless vitrectomy system for vitreoretinal surgery. Ophthalmology 109:1814–1820PubMedCrossRefGoogle Scholar
  4. 4.
    Eckardt C (2005) Transconjunctival sutureless 23-gauge vitrectomy. Retina 25:208–211PubMedCrossRefGoogle Scholar
  5. 5.
    Hikichi T, Matsumoto N, Ohtsuka H, Higuchi M, Matsushita T, Ariga H, Kosaka S, Matsushita R (2009) Comparison of one-year outcomes between 23- and 20-gauge vitrectomy for preretinal membrane. Am J Ophthalmol 147:639–643PubMedCrossRefGoogle Scholar
  6. 6.
    Rizzo S, Genovesi-Ebert F, Murri S, Belting C, Vento A, Cresti F, Manca ML (2006) 25-gauge, sutureless vitrectomy and standard 20-gauge pars plana vitrectomy in idiopathic epiretinal membrane surgery: a comparative pilot study. Graefes Arch Clin Exp Ophthalmol 244:472–479PubMedCrossRefGoogle Scholar
  7. 7.
    Haas A, Seidel G, Steinbrugger I, Maier R, Gasser-Steiner V, Wedrich A, Weger M (2010) Twenty-three-gauge and 20-gauge vitrectomy in epiretinal membrane surgery. Retina 1:112–116CrossRefGoogle Scholar
  8. 8.
    Gupta OP, Weichel ED, Regillo CD, Fineman MS, Kaiser RS, Ho AC, McNamara JA, Vander JE (2007) Postoperative complications associated with 25-gauge pars plana vitrectomy. Ophthalmic Surg Lasers Imaging 38:270–275PubMedGoogle Scholar
  9. 9.
    Parolini B, Prigione G, Romanelli F, Cereda MG, Sartore M, Pertile G (2010) Postoperative complications and intraocular pressure in 943 consecutive cases of 23-gauge transconjunctival pars plana vitrectomy with 1-year follow-up. Retina 30:107–111PubMedCrossRefGoogle Scholar
  10. 10.
    Chylack LT Jr, Wolfe JK, Singer DM, Leske MC, Bullimore MA, Bailey IL, Friend J, McCarthy D, Wu SY (1993) The Lens Opacities Classification System III. The Longitudinal Study of Cataract Study Group. Arch Ophthalmol 111:831–836PubMedCrossRefGoogle Scholar
  11. 11.
    Charles S (2006) Debating the pros and cons of 23-g vs 25-g vitrectomy: the pros of 25-g vitrectomy. Retin Physician 3:24–25Google Scholar
  12. 12.
    Chung CP, Hsu SY, Wu WC (2001) Cataract formation after pars plana vitrectomy. Kaohsiung J Med Sci 17:84–89PubMedGoogle Scholar
  13. 13.
    Kim YK, Hyon JY, Woo SJ, Park KH, Yu YS, Chung H (2010) Surgically induced astigmatism after 23-gauge transconjunctival sutureless vitrectomy. Eye 24:799–804PubMedCrossRefGoogle Scholar
  14. 14.
    Okamoto F, Okamoto C, Sakata N, Hiratsuka K, Yamane N, Hiraoka T, Kaji Y, Oshika T (2007) Changes in corneal topography after 25-gauge transconjunctival sutureless vitrectomy versus after 20-gauge standard vitrectomy. Ophthalmology 114:2138–2141PubMedCrossRefGoogle Scholar
  15. 15.
    Avitabile T, Castiglione F, Bonfiglio V, Castiglione F (2010) Transconjunctival sutureless 25-gauge versus 20-gauge standard vitrectomy: correlation between corneal topography and ultrasound biomicroscopy measurements of sclerotomy sites. Cornea 29:19–25PubMedCrossRefGoogle Scholar
  16. 16.
    Park DH, Shin JP, Kim SY (2009) Surgically induced astigmatism in combined phacoemulsification and vitrectomy; 23-gauge transconjunctival sutureless vitrectomy versus 20-gauge standard vitrectomy. Graefes Arch Clin Exp Ophthalmol 247:1331–1337PubMedCrossRefGoogle Scholar
  17. 17.
    Inoue Y, Kadonosono K, Yamakawa T, Uchio E, Watanabe Y, Yanagi Y, Tamaki Y, Araie M (2009) Surgically-induced inflammation with 20-, 23-, and 25-gauge vitrectomy systems: an experimental study. Retina 29:477–480PubMedCrossRefGoogle Scholar
  18. 18.
    Nam Y, Chung H, Lee JY, Kim JG, Yoon YH (2010) Comparison of 25- and 23-gauge sutureless microincision vitrectomy surgery in the treatment of various vitreoretinal diseases. Eye 24:869–874PubMedCrossRefGoogle Scholar
  19. 19.
    Woo SJ, Park KH, Hwang JM, Kim JH, Yu YS, Chung H (2009) Risk factors associated with sclerotomy leakage and postoperative hypotony after 23-gauge transconjunctival sutureless vitrectomy. Retina 29:456–463PubMedCrossRefGoogle Scholar
  20. 20.
    Singh RP, Bando H, Brasil OF, Williams DR, Kaiser PK (2008) Evaluation of wound closure using different incision techniques with 23-gauge and 25-gauge microincision vitrectomy systems. Retina 28:242–248PubMedCrossRefGoogle Scholar
  21. 21.
    Chieh JJ, Rogers AH, Wiegand TW, Baumal CR, Reichel E, Duker JS (2009) Short-term safety of 23-gauge single-step transconjunctival vitrectomy surgery. Retina 29:1486–1490PubMedCrossRefGoogle Scholar
  22. 22.
    Singh CN, Iezzi R, Mahmoud TH (2010) Intraocular pressure instability after 23-gauge vitrectomy. Retina 30:629–634PubMedCrossRefGoogle Scholar
  23. 23.
    Desai UR, Alhalel AA, Schiffman RM, Campen TJ, Sundar G, Muhich A (1997) Intraocular pressure elevation after simple pars plana vitrectomy. Ophthalmology 104:781–786PubMedGoogle Scholar
  24. 24.
    Wilensky JT, Goldberg MF, Alward P (1997) Glaucoma after pars plana vitrectomy. Trans Sect Ophthalmol Am Acad Ophthalmol Otolaryngol 83:114–121Google Scholar
  25. 25.
    Han DP, Lewis H, Lambrou FH Jr, Mieler WF, Hartz A (1989) Mechanisms of intraocular pressure elevation after pars plana vitrectomy. Ophthalmology 96:1357–1362PubMedGoogle Scholar
  26. 26.
    Chung SE, Kim KH, Kang SW (2009) Retinal breaks associated with the induction of posterior vitreous detachment. Am J Ophthalmol 147:1012–1016PubMedCrossRefGoogle Scholar
  27. 27.
    Tabandeh H, Chaudhry NA, Smiddy WE (1999) Retinal detachment associated with macular hole surgery: characteristics, mechanism, and outcomes. Retina 19:281–286PubMedCrossRefGoogle Scholar
  28. 28.
    Sjaarda RN, Glaser BM, Thompson JT, Murphy RP, Hanham A (1995) Distribution of iatrogenic retinal breaks in macular hole surgery. Ophthalmology 102:1387–1392PubMedGoogle Scholar
  29. 29.
    Shimada H, Nakashizuka H, Hattori T, Mori R, Mizutani Y, Yuzawa M (2008) Incidence of endophthalmitis after 20- and 25-gauge vitrectomy causes and prevention. Ophthalmology 115:2215–2220PubMedCrossRefGoogle Scholar
  30. 30.
    Cohen SM, Flynn HW Jr, Murray TG, Smiddy WE (1995) Endophthalmitis after pars plana vitrectomy. The Postvitrectomy Endophthalmitis Study Group. Ophthalmology 102:705–712PubMedGoogle Scholar
  31. 31.
    Chen JK, Khurana RN, Nguyen QD, Do DV (2009) The incidence of endophthalmitis following transconjunctival sutureless 25- vs 20-gauge vitrectomy. Eye 23:780–784PubMedCrossRefGoogle Scholar
  32. 32.
    Kunimoto DY, Kaiser RS (2007) Incidence of endophthalmitis after 20- and 25-gauge vitrectomy. Ophthalmology 114:2133–2137PubMedCrossRefGoogle Scholar
  33. 33.
    Scott IU, Flynn HW Jr, Dev S, Shaikh S, Mittra RA, Arevalo JF, Kychenthal A, Acar N (2008) Endophthalmitis after 25-gauge and 20-gauge pars plana vitrectomy: incidence and outcomes. Retina 28:138–142PubMedCrossRefGoogle Scholar
  34. 34.
    Hu AY, Bourges JL, Shah SP, Gupta A, Gonzales CR, Oliver SC, Schwartz SD (2009) Endophthalmitis after pars plana vitrectomy: a 20- and 25-gauge comparison. Ophthalmology 116:1360–1365PubMedCrossRefGoogle Scholar
  35. 35.
    Tewari A, Shah GK, Fang A (2008) Visual outcomes with 23-gauge transconjunctival sutureless vitrectomy. Retina 28:258–262PubMedCrossRefGoogle Scholar
  36. 36.
    De Preobrajensky N, Mrejen S, Adam R, Ayello-Scheer S, Gendron G, Rodallec T, Sahel JA, Barale PO (2010) 23-gauge transconjunctival sutureless vitrectomy: a retrospective study of 164 consecutive cases. J Fr Ophtalmol 33:99–104PubMedCrossRefGoogle Scholar
  37. 37.
    Gupta OP, Ho AC, Kaiser PK, Regillo CD, Chen S, Dyer DS, Dugel PU, Gupta S, Pollack JS (2008) Short-term outcomes of 23-gauge pars plana vitrectomy. Am J Ophthalmol 146:193–197PubMedCrossRefGoogle Scholar
  38. 38.
    Parolini B, Romanelli F, Prigione G, Pertile G (2009) Incidence of endophthalmitis in a large series of 23-gauge and 20-gauge transconjunctival pars plana vitrectomy. Graefes Arch Clin Exp Ophthalmol 247:895–898PubMedCrossRefGoogle Scholar
  39. 39.
    Scott IU, Flynn HW Jr, Acar N, Dev S, Shaikh S, Mittra RA, Arevalo JF, Kychenthal A, Kunselman A (2011) Incidence of endophthalmitis after 20-gauge vs 23-gauge vs 25-gauge pars plana vitrectomy. Graefes Arch Clin Exp Ophthalmol 249:377–380PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  • Otman Sandali
    • 1
  • Mohamed El Sanharawi
    • 1
  • Nicolas Lecuen
    • 1
  • Pierre-Olivier Barale
    • 1
  • Sebastien Bonnel
    • 1
  • Elena Basli
    • 1
  • Vincent Borderie
    • 1
  • Laurent Laroche
    • 1
  • Claire Monin
    • 1
  1. 1.Centre Hospitalier National d’Ophtalmologie des XV–XXParisFrance

Personalised recommendations