RETINAL, VITREOUS AND MACULAR DISORDERS: Edited by Brandon G. Busbee and John W. KitchensClinical comparison of 27-gauge and 23-gauge instruments on the outcomes of pars plana vitrectomy surgery for the treatment of vitreoretinal diseasesCharles, Stevea; Ho, Allen C.b; Dugel, Pravin U.c; Riemann, Chris D.d; Berrocal, María H.e; Gupta, Sunilf; Hamilton, Codyg; Abulon, Dina Joy K.gAuthor Information aFrom the Charles Retina Institute, Memphis, Tennessee bWills Eye Hospital, Philadelphia, Pennsylvania cRetinal Consultants of Arizona, Phoenix, Arizona dCincinnati Eye Institute and University of Cincinnati, Cincinnati, Ohio, USA eBerrocal and Associates, San Juan, Puerto Rico fRetina Specialists, Pensacola, Florida gAlcon Research, Ltd, Irvine, California, USA Correspondence to Steve Charles, MD, Charles Retina Institute, Memphis, TN, USA. E-mail: email@example.com Current Opinion in Ophthalmology: May 2020 - Volume 31 - Issue 3 - p 185-191 doi: 10.1097/ICU.0000000000000659 Buy Metrics Abstract Purpose of review To compare outcomes of 27-gauge and 23-gauge pars plana vitrectomy (PPV) for treatment of vitreoretinal diseases. Recent findings Sixty-eight patients undergoing microincisional PPV for treatment of vitreoretinal diseases were randomized 1 : 1 to 27-gauge or 23-gauge surgery with a 7500 cuts-per-minute vitrectomy probe. The most common reasons for vitrectomy were epiretinal membrane (49%) and vitreous hemorrhage (24%). Mean ± standard deviation (SD) changes from immediate preoperative to immediate postoperative intraocular pressure were −0.40 ± 6.60 mmHg in the 27-gauge and −3.05 ± 7.64 mmHg in the 23-gauge group (adjusted mean difference 2.42 mmHg, 95% lower confidence limit 0.64, P = 0.013), but these changes were not associated with primary reason for vitrectomy (P = 0.065). Mean ± SD conjunctival edema grades in the 27-gauge and 23-gauge groups 1 week after surgery were 0.02 ± 0.124 and 0.10 ± 0.246, respectively (least squares mean difference −0.09, 95% upper confidence limit −0.03, P = 0.004), and were 0.01 ± 0.122 and 0.12 ± 0.338, respectively, at the probe incision site. Conjunctival edema grades were similar in both groups at 1 and 3 months. Mean ± SD pain ratings on postoperative day 1 – an indicator of patient comfort – were similar in the two groups. Summary Smaller diameter vitrectomy instruments are associated with smaller reductions in immediate postoperative intraocular pressure. Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.