[Scope and limititions of innovative vitrectomy systems].
OBJECTIVE
The aim of the present article is to review the methodical and technological development of pars plana vitrectomy. Special attention is drawn to safety, efficiency and functionality of the innovative 25-gauge und 23-gauge vitrectomy systems which are compared to the standard 20-gauge vitrectomy system. This was done based on clinical studies and case reports.


METHODS
A literature search was conducted in a cluster of different medical databases (XMedall; XPharmall). Focus of the research was the "development" and "status quo" of pars plana vitrectomy. In particular, clinical studies and case reports dealing with safety and efficiency of 20-, 23- and 25-gauge vitrectomy systems have been evaluated. Only peer-reviewed articles from 1966 until today were investigated. Finally, a descriptive analysis of the relevant studies was made.


RESULTS
Both innovative vitrectomy systems are safe and effective and help to reduce operating time. There was no significant difference in postoperative complications following 25-gauge vitrectomy and 20-gauge vitrectomy. 25-gauge instruments, however, show a greater flexibility. For this reason a certain learning curve is required and the range of application is limited. Due to its greater stiffness and larger diameter, the 23-gauge system - while still allowing a transconjunctival access - may overcome the disadvantages of the 25-gauge system. However, the use of silicone oil may lead to leakage of the sclerotomies and thus necessitate additional suturing.


CONCLUSIONS
The use of both innovative vitrectomy systems offers the advantage of a faster and less invasive surgical procedure. However, there are disadvantages which limit the indications for 25-gauge vitrectomy. The 23-gauge vitrectomy may overcome these disadvantages and - due to its wider range of application - may be used instead of conventional 20-gauge vitrectomy in most cases. It may therefore become the new standard for vitrectomy.
Augustin
A J
AJ
Augenklinik, Klinikum Karlsruhe. 106020.560@compuserve.com
Offermann
I
I
D004526:Efficiency; D004867:Equipment Design; D004869:Equipment Safety; D005119:Extravasation of Diagnostic and Therapeutic Materials / Q000601:surgery; D006801:Humans; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications / Q000601:surgery; D012599:Sclerostomy / Q000295:instrumentation; D012827:Silicone Oils / Q000008:administration & dosage; D013536:Suture Techniques; D014821:Vitrectomy / Q000295:instrumentation*
D012827:Silicone Oils