A Report by the American Academy of Ophthalmology Ophthalmic Technology Assessment Committee Retina/Vitreous Panel: Franco M. Recchia, MD1; Ingrid U. Scott, MD, MPH2; Gary C. Brown, MD, MBA3; Melissa M. Brown, MD, MBA3; Allen C. Ho, MD4; Michael S. Ip, MD5
Ophthalmology, September 2010, Vol. 117, 1851-1857 © 2010 by the American Academy of Ophthalmology. Click here for free access to the OTA.
Objective: To review available peer-reviewed publications to evaluate the safety profile and visual outcomes associated with small-gauge pars plana vitrectomy.
Methods: Literature searches of the PubMed and the Cochrane Library databases were last conducted on August 5, 2009, with no date restrictions. The searches were limited to articles published in English. These searches retrieved 328 articles, of which 76 were deemed topically relevant and rated according to strength of evidence.
Results: On the basis of level II and level III evidence, the overall safety profile of small-gauge pars plana vitrectomy is similar to that established for conventional 20-gauge pars plana vitrectomy and provides comparable visual acuity results. An increased incidence of infectious endophthalmitis following 25-gauge vitrectomy was reported in 2 comparative studies, but this was not confirmed by multiple, larger, more recent reports, perhaps due to modifications in case selection and surgical technique over time. Compared with 20-gauge vitrectomy, small-gauge vitrectomy is associated with significantly lower levels of patient discomfort and ocular inflammation, and the time required for improvement in visual acuity is shorter.
Conclusions: The technological advances of small-gauge vitrectomy seem to afford visual benefit comparable to that seen with traditional 20-gauge surgery, with more rapid healing, less discomfort, and an acceptably low incidence of adverse events comparable with those observed with conventional 20-gauge vitrectomy. As surgical techniques evolve and clinical experience grows, continued close surveillance is necessary for an accurate assessment of complications.
1Division of Vitreoretinal Diseases and Surgery, Vanderbilt Eye Institute, Nashville, Tennessee
2Penn State College of Medicine, Hershey Eye Center, Hershey, Pennsylvania
3Center for Value-Based Medicine, Flourtown, Pennsylvania
4Wills Eye Institute, Philadelphia, Pennsylvania; Mid Atlantic Retina, Wyndmoor, Pennsylvania; Professor of Ophthalmology, Thomas Jefferson University, Philadelphia, Pennsylvania
5Department of Ophthalmology and Visual Sciences, University of Wisconsin, Madison, Wisconsin