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    Surgery with 25- and 27-gauge tools mostly similar with minor variances

    Immediate wound closure more common with 27 gauge; cut rate parameters different

    Take-home message: A comparison of small-gauge instrumentation reveals some subtle differences in surgical technique.


    West Des Moines, IA—Smaller-gauge instruments do not significantly lengthen the amount of time required for vitrectomy, and increase the frequency of immediate wound closure, according to Jared Nielsen, MD.

    Dr. Nielsen, of the Wolfe Eye Clinic in West Des Moines, IA, presented a case series comparing 25- and 27-gauge instrumentation (Alcon Constellation Valved Trocar).

    “Patients universally seemed to really like the 27-gauge surgery,” he said. “Even though we’re using much smaller instruments, surgery doesn’t take appreciably longer.”

    Dr. Nielsen said he was immediately interested when he heard about the smaller instruments, but worried that the surgery would be more time consuming. Once he started using them, he did find some differences in technique.

    “They’re a little bit more flexible,” he said. “They’re a little more apt to bend. It takes some getting use to. But after about 20 cases, it became my gauge of choice. Now I do all of my less complex cases with 27-gauge.”

    For example, the size of the light pipe is smaller. By increasing illumination at the source of the light, he found he could see well enough. In addition, he had to be more vigilant to remove anterior vitreous.


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