title: 25-, 23-, and 20-gauge vitrectomy in epiretinal membrane surgery: a comparative study of 553 cases.
abstract: OBJECTIVE
  To compare the safety and functional outcomes of 25-gauge and 23-gauge (G) micro-incision vitrectomy surgery (MIVS) instrumentation with the standard 20-G vitrectomy system in the treatment of epiretinal membranes (ERM).
  
  
  METHODS
  A retrospective comparative study of 553 consecutive cases with epiretinal membrane who underwent pars plana vitrectomy. Twenty-gauge, 25-gauge and 23-gauge vitrectomy was performed respectively in 347, 91, and 115 eyes. Surgery duration, visual acuity improvement, intraocular pressure variation, intraoperative and postoperative complications were analyzed.
  
  
  RESULTS
  The mean surgical time in the 23-G group and in the 25-G group was shorter than in the 20-G group (P < 0.001). Visual improvement was higher 8 days postoperatively in the 25-G group than in the 20-G and 23-G groups (P = 0.035), but not at 6 weeks postoperatively (P = 0.186). In the 20-G group, the IOP increased significantly on the first day postoperatively (P < 0.001), while in the 23-G group, the IOP decreased on the first day postoperatively (P = 0.073). In the 25-G group, the IOP did not change significantly (P = 0.807). The incidence of complications was not statistically significant between the three groups. Retinal breaks were significantly related to the induction of posterior vitreous detachment, independent of the system gauge.
  
  
  CONCLUSIONS
  In ERM surgery, 23-G and 25-G (MIVS) systems are as safe and effective as the 20-G system, and significantly reduce surgical time. Although the 25-G system provides an earlier visual improvement, the 23- and 25- gauge systems are comparable, and the selection will depend on the surgeon's preference.
authors.affiliation: Centre Hospitalier National d'Ophtalmologie des XV-XX, 28 rue de Charenton, 75571, Paris, France. sanotman1@yahoo.fr
authors.forename: Otman
authors.initials: O
authors.lastname: Sandali
authors.forename: Mohamed
authors.initials: M
authors.lastname: El Sanharawi
authors.forename: Nicolas
authors.initials: N
authors.lastname: Lecuen
authors.forename: Pierre-Olivier
authors.initials: PO
authors.lastname: Barale
authors.forename: Sebastien
authors.initials: S
authors.lastname: Bonnel
authors.forename: Elena
authors.initials: E
authors.lastname: Basli
authors.forename: Vincent
authors.initials: V
authors.lastname: Borderie
authors.forename: Laurent
authors.initials: L
authors.lastname: Laroche
authors.forename: Claire
authors.initials: C
authors.lastname: Monin
mesh_terms: D000368:Aged; D019773:Epiretinal Membrane / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D006801:Humans; D007429:Intraocular Pressure / Q000502:physiology; D007431:Intraoperative Complications; D008297:Male; D008866:Microsurgery / Q000295:instrumentation / Q000379:methods*; D011183:Postoperative Complications; D012189:Retrospective Studies; D016896:Treatment Outcome; D014792:Visual Acuity / Q000502:physiology; D014821:Vitrectomy / Q000295:instrumentation / Q000379:methods*