23-gauge vitrectomy is less painful for patients in the early postoperative period

This prospective trial randomized 60 patients to undergo either 23- or 20-gauge vitrectomy. Patients in the 23-gauge group were significantly more comfortable during the postoperative period. Both conjunctival injection and postoperative pain were significantly reduced.

However, time of surgery is almost equal. While opening and closure times were significantly shorter in the 23-gauge group, vitrectomy time was significantly longer. Postop visual acuity was similar, and there was no difference in the complication rate between the two groups.

Although this study didn't find a difference in the incidence of severe hypotony between the two groups, the authors note that this complication warrants further observation.

"In our 23-gauge group we found hypotonies in six (20%) patients, being severe (<5 mm Hg) in two (7%) on postoperative day 1. However, no statistically significant difference in postoperative eye pressure could be detected between the two groups. This stands in contrast to our previous 25- versus 20-gauge study, where significantly more hypotonies were observed in the first three postoperative days in the 25-gauge group. This is most likely related to the oblique incisions in 23-gauge vitrectomy. Fluid-air exchange at the end of surgery might be able to minimize this complication."