Vitrectomy is an eye operation usually performed by a retinal specialist to treat a variety of retinal conditions. Most vitrectomies are performed to treat:
For me, this is state of the art. A 25 gauge vitrectomy uses thinner instruments compared to the older 20 gauge vitrectomy system (the higher the number, the thinner the instruments). I have rarely used a 20 gauge system in the last 5-7 years. There really is no need.
To most, the largest advantage of the thinner system is the small incisions, or holes, needed to enter the eye. The entry areas are so small, stitches are not needed as they self-seal. This shortens the operation as I don’t have to spend time stitching the entry wounds in the sclera and conjunctiva.
While shortening operating time is great, the biggest advantage is quicker healing and comfort to the patient!
Compared to older technology, or 20 gauge vitrectomy systems, 25 gauge systems are also safer for the patient. While infection rates have been traditionally lower in retinal operations, the smaller gauge vitrectomy systems now cause far fewer retinal tears compared to the 20 gauge, larger, predecessor.
Hence, 25 gauge vitrectomy is now as safe or safer than cataract surgery.
In addition to faster operating and quicker healing, the smaller and thinner instruments cause fewer tears due to the fact that thinner instruments can not generate as much “sucking” force as wider/fatter instruments.
Try drinking through a coffee stirrer versus and drinking straw. That’s the difference between 25 gauge (thinner) and 20 gauge (thicker) instrumentation.
As a result, the newer instruments can not pull on the vitreous as forcefully as the thicker instrument.
The vitreous is very adherent to the retina in certain parts of the eye. Pulling on the vitreous can, therefore, cause a retinal tear.
What Does this Mean?
Modern vitrectomy is very safe. Fewer complications occur with the 25 gauge system. The chance of blinding infection (endophthalmitis) has always been lower in vitrectomy compared to cataract surgery. Now, with advanced technology, the thinner vitrectomy system causes far fewer retinal tears (and, therefore, retinal detachments).
While the thinner instruments do have intuitive advantages for doctor and patient such as quicker healing, fewer office visits and speedier operating time.
The fact that fewer tears are created escapes most physicians (even some retina specialists). The changes in size, smaller openings and thinner instrumentation, has allowed vitrectomy eye surgery to become a very safe surgery.