[Primary 25- and 23-gauge vitrectomy in the treatment of rhegmatogenous retinal detachment--advancement of surgical technique or erroneous trend?].

BACKGROUND: Pars plana vitrectomy techniques with 25- and 23-gauge transconjunctival systems are rapidly growing in popularity. These systems were mainly used in the treatment of macular diseases. However, an expansion to more complicated vitreoretinal procedures including the treatment of rhegmatogenous retinal detachments can currently be observed. In this review, the results and complications of 25- and 23-gauge vitrectomy techniques are analysed.
MATERIAL AND METHODS: A review has been made of the current literature concerning 25- and 23-gauge vitrectomy techniques with particular attention to the treatment of rhegmatogenous retinal detachments.
RESULTS: The benefits of 25-gauge and 23-gauge vitrectomy (shorter operating times, decreased inflammation of the anterior segment, increased patient comfort and enhanced visual recovery) are of no clinical significance when treating rhegmatogenous retinal detachments and do not seem to offer an advantage over 20-gauge vitrectomy or scleral buckling techniques. Recently published series with primary anatomic reattachment rates between 71% and 93% and a mean postoperative visual acuity of 20/50 seem to suggest a worsening of the treatment results with these new techniques. In addition, 25-gauge and 23-gauge techniques are technically challenging, associated with significant complications (for example, postoperative hypotony) and increase the risk for exogenous endophthalmitis.
CONCLUSION: New 25-gauge and 23-gauge vitrectomy techniques for rhegmatogenous retinal detachment show no advantage over scleral buckling techniques in phakic patients or 20-gauge vitrectomy in pseudophakic patients. Moreover, these techniques seem to worsen the outcome and increase the postoperative complication rate.