Purpose of review: The history and development of 25-gauge and 23-gauge vitrectomy are reviewed in this paper and compared with 20-gauge vitrectomy, the historical gold standard. Current advantages and disadvantages of each are delineated.
Recent findings: Transconjunctival sutureless vitrectomy continues to offer advantages of increased patient comfort decreased operative times and improved postoperative astigmatism. These advantages, however, must be weighed against the possibility of increased rates of postoperative hypotony and endopthalmitis.
Summary: Both 25-gauge and 23-gauge instruments continue to evolve, and have improved significantly since their introductions. Most cases can now be performed using either 25-gauge or 23-gauge techniques with success rates comparable to 20-gauge. Despite these advantages, there are still cases where 20-gauge is appropriate and preferable. Clinical experience, innovations and further studies will help dictate the future course of pars plana vitrectomy instrumentation.