Purpose: To compare the visual outcomes and occurrences of postoperative complications after 23-gauge (G) and 25-G microincision vitrectomy surgery (MIVS) for idiopathic epiretinal membrane in pseudophakic eyes. Methods: A total of 239 pseudophakic eyes of 239 patients who underwent 23-G (n = 159) or 25-G MIVS (n = 80) for removal of idiopathic epiretinal membrane between March 2010 and March 2013 were included in this retrospective study. Patients were followed up on postoperative 1 day, 1 week, 1, 3, and 6 months. Postoperative visual acuity, intraocular pressure, and intraoperative or postoperative complications were compared between the 23-G and 25-G MIVS groups. Results: Both groups showed a statistically significant improvement in best-corrected visual acuity at postoperative 1, 3, and 6 months (All P < 0.05). Furthermore, the mean change of best-corrected visual acuity was not significantly different between the 2 groups at postoperative 1, 3, and 6 months (P = 0.208, P = 0.547, and P = 0.519, respectively), but 25-G MIVS group showed faster visual recovery than 23-G MIVS group at postoperative 1 day and at 1 week (P = 0.015, and P < 0.001, respectively). Severe hypotony of intraocular pressure less than 6 mmHg (3 eyes, 1.9%) or intraocular pressure elevation over 30 mmHg at postoperative 1 day (3 eyes, 1.9%) was found in the 23-G group, but not in the 25-G group, and was not statistically different between the groups (P = 0.553). More eyes required intraoperative suturing of sclerotomy sites in the 23-G group (18 eyes, 11.3%), whereas none of the eyes in the 25-G group needed suturing of sclerotomy (P < 0.002). Conclusion: Both 23-G and 25-G MIVS yielded comparable visual outcomes for surgical treatment of idiopathic epiretinal membrane in pseudophakic eyes. The 25-G MIVS was associated with faster visual recovery and less postoperative hypotony than 23-G surgery.
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