Journal List > J Korean Ophthalmol Soc > v.54(8) > 1009453

Kim, Cho, Lee, Kim, Kim, Lee, and Han: Comparison of 20, 23 and 25 Gauge Vitreoretinal Surgical Instruments

Abstract

Purpose

To investigate the diameter, the infusion and aspiration rate of 20-, 23- and 25-gauge vitreous cutters, and com-pare the theoretical and practical intraocular pressure (IOP) change according to the height of the bottle.

Methods

A vitreous cutter was disassembled to measure the actual external and internal diameter. The infusion rate was measured at the height of 40, 60, 80, 100 and 120 cm and the suction rate was measured at a pressure of 100, 200, 300, 400 and 500 mm Hg for each gauge. IOP during the operation was calculated according to the bottle height and the actual IOP was measured using a mercury sphygmomanometer.

Results

The external diameter of the 20-, 23- and 25-gauge was 900, 596, and 500 mm, respectively, and the internal di-ameter was 670, 450, and 380 mm, respectively. The infusion rate increased in direct proportion to the bottle height. The aspiration rate increased as the pressure increased. However, the increment of the infusion and aspiration rate in the 20-gauge vitreous cutter was the highest and decreased in the 23- and 25-gauge, in that order. IOP was calculated as 29, 44, 59 and 74 mm Hg when the bottle height was at 40, 60, 80 and 100 cm, respectively, and was measured 34, 50, 62 and 74 mm Hg, respectively.

Conclusions

The infusion and aspiration rates per outer diameter in the 23- and 25-gauge vitreous cutters and infusions using cannula were lower than in the 20-gauge vitreous cutter. The difference of the infusion and aspiration rates per diam-eter between the 23- and 25-gauge vitreous cutters and infusions was not significant.

References

1. Fujii GY, De Juan E Jr, Humayun MS. . A new 25-gauge instru-ment system for transconjunctival sutureless vitrectomy surgery. Ophthalmology. 2002; 109:1807–12.
2. Eckardt C. Transconjunctival sutureless 23-gauge Vitrectomy. Retina. 2005; 25:208–11.
crossref
3. de Juan E Jr, Hickingbotham D. Refinements in microinstrumentation for vitreous surgery. Am J Ophthalmol. 1990; 109:218–20.
crossref
4. Hubschman JP. [Comparison of different vitrectomy systems.]. J Fr Ophtalmol. 2005; 28:606–9.
5. Romero P, Salvat M, Almena M. . [Experience with 25-gauge transconjunctival vitrectomy compared to a 20-gauge system. Analysis of 132 cases.] J Fr Ophtalmol. 2006; 29:1025–32.
6. Spirn MJ. Comparison of 25, 23 and 20-gauge vitrectomy. Curr Opin Ophthalmol. 2009; 20:195–9.
crossref
7. Thompson JT. Advantages and limitations of small gauge vitrectomy. Surv Ophthalmol. 2011; 56:162–72.
crossref
8. Kim SH, Choi KS. Changes of intraocular pressure during experimental vitrectomy. Curr Eye Res. 2012; 37:698–703.
crossref
9. Haas A, Seidel G, Steinbrugger I. . Twenty-three-gauge and 20-gauge vitrectomy in epiretinal membrane surgery. Retina. 2010; 30:112–6.
crossref

Figure 1.
(A) Photographs of 20-, 23-, 25-gauge vitre-ous cutters. (B) Enlarged photograph of outer and inner tube of 23-gauge vitreous cutter (a: external diameter of outer tube, b: external diameter of inner tube, c: hori-zontal diameter of cutter opening, d: vertical diameter of cutter opening, e: thickness of outer tube).
jkos-54-1236f1.tif
Figure 2.
The measurement of infusion pressure. (A) Balanced salt solution and line are directly connected to mer-cury sphygmomanometer. (B) Three way catheter is connected with balanced salt solution and line, infusion line and mercury sphygmomanometer.
jkos-54-1236f2.tif
Figure 3.
Balanced salt solution infusion rate according to the bottle height using the 20-gauge, 23-gauge, 25-gauge infusion cannula.
jkos-54-1236f3.tif
Figure 4.
Balanced salt solution aspiration rate according to the aspiration vacuum using the 20-gauge, the 23-gauge and the 25-gauge vitreous cutter.
jkos-54-1236f4.tif
Figure 5.
Intraocular pressure change according to the bottle height calculated by nomogram.
jkos-54-1236f5.tif
Table 1.
Compa rison of 20-, 23- and 25-gauge e vitreous cutters and infusions
Gauge Outer D* (%) Inner D (%) Infusion rate (%) Aspiration rate§ (%)
20 900 (100) 670 (100) 0.98 (100) 0.34 (100)
23 596 (66) 450 (67) 0.42 (43) 0.08 (24)
25 500 (56) 390 (58) 0.15 (15) 0.04 (11)

* Outer diameter of outer tube of vitreous cutter, μ m;

Outer diameter of inner tube of vitreous cutter, μ m;

Mean of all other bottle heights, cc/sec;

§ Mean of all other aspiration power, cc/sec.

TOOLS
Similar articles