By Yusuke Oshima MD; Taku Wakabayashi MD; Yasuo Tano MD

    Wound sealing–related complications such as hypotony and postoperative endophthalmitis are the major concerns recognized in the current microincision vitrectomy surgery (MIVS) with 23- or 25-gauge instruments. To eliminate the complex techniques for creating self-sealing wound structures and the concerns about wound leakage in MIVS, we developed a 27-gauge vitrectomy system with a variety of vitreoretinal instruments for transconjunctival sutureless MIVS. Easy entry and removal of surgical instruments, sufficient endoillumination, safer intraocular manipulations, and perfect wound self-sealing can be achieved with a 27-gauge system. The feasibility, safety, simplicity, and surgical tips of 27-gauge MIVS for macular surgery and diabetic vitrectomy are highlighted in this video.