Hybrid 25- and 27-Gauge Vitrectomy for Complex Vitreoretinal Surgery

Abstract

BACKGROUND AND OBJECTIVE: The authors report the technique of using the 27-gauge (G) vitreous cutter through 25-G valved cannulas to allow hybrid instrumentation of both gauges. PATIENTS AND METHODS: Vitrectomy is initiated with standard placement of 25-G valved cannulas, followed by insertion of a 27-G vitreous cutter through the 25-G cannulas. RESULTS: The hybrid procedure emphasizes the advantages of both platforms: The 25-G cutter is more efficient for core vitrectomy and is more rigid to facilitate peripheral vitrectomy; the 25-G platform enjoys a wider armamentarium of instrumentation options; and the smaller profile of the 27-G cutter can be maneuvered more easily into tight surgical planes to act analogous to vertical scissors, with the added benefits of aspiration and spatula-like features. The authors illustrate this technique in three cases: diabetic tractional retinal detachment with dense plaques, posterior stage 4B retinopathy of prematurity, and sutureless scleral fixation of an intraocular lens. CONCLUSIONS: Hybrid use of the 25-G and 27-G platforms offers greater versatility for the management of complex vitreoretinal conditions.