Twenty-seven-gauge vitrectomy for various vitreoretinal diseases

Small-gauge vitrectomy has become very popular since its introduction. Fujii et al developed a 25-gauge sutureless transconjunctival system in 2002, and Eckardt introduced a 23-gauge system in 2005. Subsequently, Oshima et al4 introduced a 27-gauge vitrector and demonstrated good surgical results. These vitrectors have simplified the surgical procedure and offer advantages, such as reduced corneal astigmatism, diminished conjunctival scarring, decreased postoperative inflammation, improved patient comfort, and, sometimes, earlier visual recovery. The trend of using increasingly smaller instruments with higher cutting rates is based on the fact that such technologies should be safer because they increase fluid stability and potentially minimize vitreous turbulence by allowing only small vitreous pieces to enter the aspiration port. High cutting rates also reduce the likelihood of uncut vitreous fibers entering the cutter port, thereby reducing risk of iatrogenic damage to the retinal surface and intraoperative retinal tears. Retinal traction is reduced and thereby the risk of retinal breaks, as shown both clinically and experimentally.Twenty-seven–gauge sclerotomies may show even better closure than 25-gauge sclerotomies. Here, we report our initial experience and discuss the feasibility of a 27-gauge vitrectomy system for various vitreoretinal diseases drawing special attention on the closure rate of the sclerotomies and iatrogenic retinal breaks.