Visual recovery after vitrectomy for macular hole using 25-gauge instruments.

PURPOSE: To determine whether vitrectomy with 25-gauge instruments contributes to better postoperative visual recovery after macular hole (MH) surgery. METHODS: The medical records for 46 consecutive eyes operated for MH by a single surgeon were retrospectively examined. Vitrectomy had been performed with a 25-gauge instrument in 23 eyes (25-G group) and with a 20-gauge instrument in 23 eyes (20-G group). Postoperative visual acuity (VA) in logMAR (logarithm of the minimum angle of resolution) units after 1 week and 1, 3, 6, 9 and 12 months, operating time, and volume of intraocular irrigating fluid were compared between the two groups. RESULTS: Mean preoperative logMAR VA was 0.72 in the 25-G group and 0.68 in the 20-G group (p = 0.282, unpaired t-test). One week after surgery, VA was significantly better in the 25-G group (0.40 +/- 0.34) than in the 20-G group (0.58 +/- 0.30) (p = 0.020). This significant difference was maintained until 9 months after surgery, but was no longer evident at 12 months (p = 0.182). Operating time was significantly shorter in the 25-G group (56 +/- 16 mins) than in the 20-G group (85 +/- 28 mins) (p = 0.003, unpaired t-test). The volume of intraocular irrigating fluid was significantly less in the 25-G group (244 +/- 72 ml) than in the 20-G group (416 +/- 113 ml) (p < 0.0001). CONCLUSIONS: The use of 25-gauge vitrectomy instruments leads to better postoperative visual recovery following surgery for MH during the first 9 months, probably as a result of shorter surgical time and a lower volume of intraocular irrigating fluid.