The portfolio of retinal instruments continues to expand with a growing line of tools offering surgeons improved work efficiency while promoting better surgical outcomes with 27-gauge instruments.
“Clinicians generally believe that smaller is better when it comes to retina instruments and, to a certain extent, they are right,” said Kevin J. Blinder, MD.
“When you use 27-gauge instruments--which I have been doing a fair bit recently--the surgical wounds are 100% self-sealing,” said Dr. Blinder, The Retina Institute, St. Louis, and professor of clinical ophthalmology and visual sciences, Washington University School of Medicine, St. Louis. “I have not seen any leaks in my patients to this point. Using smaller instrumentation is making sutures almost obsolete.”
Patients also tend to feel and look better after surgery using the smaller instruments, he said.
They tend to be more comfortable on the first postoperative day. Swelling and other visual signs of surgical trauma can be so minor that some patients look as though they have not undergone anything more invasive than an eye exam.
Improving from 20-gauge
Surgical instrument makers have long been working to reduce instrument size, but materials, technology, and manufacturing techniques have not always been able to meet surgeons’ needs. The standard for most retina instruments was 20-gauge (0.03575 inch nominal exterior diameter) for many years, Dr. Blinder said.
Surgeons were initially excited by the first 25-gauge instruments (0.02025 inch diameter), but disappointed at the lack of rigidity and control. The new generation of smaller instruments felt flimsy and difficult to control, resulting in too many less-than-ideal surgical outcomes.
The industry then retreated to 23-gauge (0.02825 inch diameter), in which the larger diameter instruments provided more rigidity and greater control. The manufacturing and material lessons learned in the development of 23-gauge instruments were applied to a new generation of 25-gauge tools. The newer iteration of 25-gauge provided a degree of rigidity and ease of control similar to 23-gauge devices, while causing less trauma during surgery. The current generation of 27-gauge instruments feels very similar to 25-gauge.
“I don’t see a lot of difference intraoperatively between 25- and 27-gauge, which is a desirable thing,” Dr. Blinder said. “Where I do see the difference is postoperatively, especially during the first day.”
The use of 27-gauge instrumentation makes for a less-invasive procedure than with larger gauge instruments, but the availability of 27-gauge products has been somewhat limited, he noted.
“These new products offer the control and usability typically provided by 23- and 25-gauge instruments with the added benefits of small size, which may help surgeons work more safely, efficiently, and effectively,” he said.