COMPARISON OF OUTCOMES BETWEEN 23-GAUGE AND 25 GAUGE PARS PLANA VITRECTOMY IN RETINAL DETACHMENT REPAIR

Abstract

Background: Pars plana vitrectomy is widely used for rhegmatogenous retinal detachment repair, with both 23-gauge and 25-gauge systems offering minimally invasive approaches. Objective: To compare the anatomical, visual, operative, and postoperative outcomes of 23-gauge and 25-gauge pars plana vitrectomy in patients undergoing retinal detachment repair. Methods: This retrospective comparative cohort study was conducted at  department of Ophthalmology, Akhtar Saeed Medical & Dental College, Lahore from January 2025 to July 2025, and included 150 patients with rhegmatogenous retinal detachment. Demographic and baseline ophthalmic characteristics including age, gender, affected eye, lens status, duration of symptoms, macular status, extent of retinal detachment, number and location of retinal breaks, baseline best-corrected visual acuity (BCVA), and intraocular pressure (IOP) were recorded. Results: Baseline characteristics were comparable between groups. Mean operative time was significantly shorter with 25-gauge PPV than with 23-gauge PPV (58.16±13.75 vs. 63.48±14.62 minutes, p=0.023), and sclerotomy suturing was required less frequently (8.0% vs. 20.0%, p=0.035). Final BCVA was similar between the 23-gauge and 25-gauge groups (0.43±0.34 vs. 0.40±0.32 logMAR, p=0.578), with identical mean visual improvement of 0.75 logMAR. Primary anatomical success was 89.3% versus 92.0%, while final anatomical success was 97.3% versus 98.7%, respectively. Recurrent retinal detachment occurred in 10.7% and 8.0% of patients. Conclusion: Both 23-gauge and 25-gauge pars plana vitrectomy provided comparable visual and anatomical outcomes with similar safety profiles in retinal detachment repair. The 25-gauge technique demonstrated shorter operative time and reduced need for sclerotomy suturing, suggesting modest intraoperative advantages without compromising surgical success.