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 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 25-G group (76.7% vs. 16.1%, 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.