Intraoperative precision of 25-gauge beveled-tip versus 23-gauge flat-tip probes
in day surgery vitrectomy for proliferative diabetic retinopathy: a comparative
cohort study
#MMPMID41194258
Xue D
; Zhang Y
; Kang Z
; Zheng J
; He Y
; Luo X
Int J Retina Vitreous
2025[Nov]; 11
(1
): 123
PMID41194258
show ga
BACKGROUND: To compare the intraoperative performance and safety of the 10k
cuts-per-minute (cpm)/25-gauge (G) beveled-tip probe (BTP) versus the 5k-cpm/23-G
flat-tip probe (FTP) in microincision vitrectomy surgery (MIVS) for proliferative
diabetic retinopathy (PDR). METHODS: This comparative interventional cohort study
enrolled 173 eyes of 156 consecutive patients with PDR. Eyes underwent MIVS by a
single surgeon from April 2022 to June 2023, utilizing either the 10k/25-G BTP
(study group) or the 5k/23-G FTP (control group). All patients completed 3-month
protocolized follow-up; 72.8% (126 eyes) had extended observational tracking to 6
months. Intraoperative parameters (instrument exchange, endodiathermy
application), surgical times, and postoperative outcomes were analyzed. Main
Outcome Measures: Rate of instrument exchange, number of endodiathermy
applications, and operative time. RESULTS: Baseline demographics and operative
characteristics were comparable between groups. Total operative time
(63.30?±?18.38 vs. 59.84?±?19.28 min, P?=?0.14) and vitrectomy time
(36.55?±?15.54 vs. 35.59?±?16.59, P?=?0.67) did not differ significantly. The
25-G BTP group demonstrated a 41% reduction in instrument exchanges (1.31?±?2.02
vs. 2.22?±?2.71, P?=?0.003) and required 58% fewer endodiathermy applications
(2.28?±?3.33 vs. 5.49?±?6.49 sites, P?0.0001). Sutureless sclerotomy rates were
higher in the 23-G group (83.9% vs. 23.3%, P?0.0001). Postoperative
best-corrected visual acuity improvement, complication rates, and intraocular
pressure control were equivalent between groups at 3 months and 6 months.
CONCLUSIONS: While both systems achieve equivalent visual and anatomical outcomes
in PDR surgery, the 10k/25-G BTP system facilitates a novel ?Trim and Excision?
Technique, enabling more precise dissection of fibrovascular tissue. This
technique translates to superior intraoperative efficiency and safety,
significantly reducing instrument dependence and iatrogenic hemorrhage without
compromising surgical speed or postoperative recovery. CLINICAL TRIAL
REGISTRATION: This trial is registered with the Chinese Clinical Trial Registry
(http://www.chictr.org.cn, registration number ChiCTR2300067743). Date of
registration: 2023-01-20. SUPPLEMENTARY INFORMATION: The online version contains
supplementary material available at 10.1186/s40942-025-00746-6.