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

Background To compare the intraoperative precision of 10k/25-gauge (G) beveled-tip probe (BTP) versus 5k/23-G flat-tip probe (FTP) vitrectomy for the treatment of proliferative diabetic retinopathy (PDR). Methods This comparative cohort interventional case series study enrolled 173 eyes with PDR in 156 consecutive patients who underwent vitrectomy with either 10k/25-G BTP (study group) or 5k/23-G FTP (control group) by the same surgeon from April 2022 to June 2023. All patients were followed for at least three months after surgery. Intraoperative videos were recorded, and the differences in the demographics, electrocoagulation rate, instrument exchange, actual vitrectomy time, and postoperative complications were evaluated. Results No significant differences were found between the two groups in all baseline and most operative characteristics, including surgery and vitrectomy time, use of endo tamponade agent, occurrence of abnormal postoperative intraocular pressure, best corrected visual acuity (BCVA) improvement, recurrent severe vitreous hemorrhage and other complications. Significantly fewer sclerotomies sutures, instrument exchange, and use of bipolar endo diathermy were observed in the 25-G group. Conclusions Both 23-G FTP and 25-G BTP have comparable visual and anatomical outcomes in MIVS in day surgery for treating PDR patients. Compared with the 23-G FTP, which usually exploits suction to lift and shave the proliferative membranes, the 25-G BTP could directly remove the proliferative membranes using the “Trim and Excision” technique, which is safer to reduce the risk of iatrogenic vascular rupture and intraoperative bleeding, as well as decrease the intraoperative exchange of instruments and sclerotomy sutures. 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.