25- Versus 27-Gauge Vitrectomy for Idiopathic Epiretinal Membrane: Operative Time and Outcomes in a Homogeneous Cohort

25- Versus 27-Gauge Vitrectomy for Idiopathic Epiretinal Membrane: Operative Time and Outcomes in a Homogeneous Cohort | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article 25- Versus 27-Gauge Vitrectomy for Idiopathic Epiretinal Membrane: Operative Time and Outcomes in a Homogeneous Cohort Ekrem Celik, Evrim Polat This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7802678/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 9 You are reading this latest preprint version Abstract Background To compare operative efficiency, efficacy, and safety of 25-gauge (25G) versus 27-gauge (27G) microincision vitrectomy systems for idiopathic epiretinal membrane (ERM) surgery in a homogeneous cohort. Methods Retrospective, single-center series of consecutive eyes operated between March 2021 and January 2023, with ≥ 12-month follow-up. All surgeries were performed by the same vitreoretinal surgeon using a standardized platform. Outcomes included best-corrected visual acuity (BCVA, logMAR), intraocular pressure (IOP), central macular thickness (CMT), ERM–ILM peel time, core vitrectomy time, total surgical time, and 12-month metamorphopsia (Amsler grid). Intraoperative instrument use (light probe and vitrectomy cutter: single vs ≥ 2) was recorded. Results A total of 107 eyes were analyzed (27G, n = 68; 25G, n = 39). Baseline age, sex, and lens status did not differ between groups. ERM–ILM peel duration was longer with 25G (9.4 ± 2.5 vs 8.1 ± 2.2 min; P = 0.073). Core vitrectomy and total surgical times were longer with 27G (core: 27.8 ± 10.8 vs 21.8 ± 9.1 min, P = 0.014; total: 45.6 ± 9.4 vs 38.1 ± 10.4 min, P = 0.001). BCVA improved significantly in both groups with no between-group differences at any visit through month 12. During follow-up, IOP and CMT values were also similar between groups (all P > 0.05). Twelve-month metamorphopsia was statistically similar between the 27G and 25G groups (52.9% vs 41.0%; P = 0.235). Although 27G instruments are more flexible and occasionally deformed intraoperatively, the need to replace light probes or vitrectomy cutters due to bending was not significantly different from 25G (light 6/68 vs 1/39; cutter 4/68 vs 1/39; both P > 0.05). Conclusion In idiopathic ERM surgery, 25- and 27-gauge systems achieve similar 12-month visual and anatomical outcomes. Operative profiles differ: 27G is associated with longer core and total times, whereas 25G shows longer peeling time. These differences likely reflect instrument rigidity/flexibility rather than efficacy. Gauge selection may be individualized according to surgical priorities (time efficiency versus minimal incision). Epiretinal membrane Microincision vitrectomy 25-gauge 27-gauge surgical time Figures Figure 1 Figure 2 Figure 3 Introduction Idiopathic epiretinal membrane (ERM) is a prevalent macular disorder whose incidence rises sharply with advancing age-reported prevalences include approximately 7.2% in individuals aged 60–69 years and up to 11.6–12% among those aged 70 years and older [ 1 , 2 ]. Though often asymptomatic in its early stages, ERM commonly presents with central visual distortion and metamorphopsia, significantly impacting daily life in elderly patients. When such functional impairment becomes clinically relevant, pars plana vitrectomy (PPV) combined with ERM–ILM peeling stands as the standard surgical treatment and has demonstrated favorable visual and anatomical outcomes [ 3 , 4 ]. Over the last two decades, the shift toward transconjunctival microincision vitrectomy surgery (MIVS) has progressively reduced incision size from 23-gauge to 25-gauge and, more recently, to 27-gauge, with the aims of minimizing surgical trauma, accelerating wound sealing, and improving early postoperative comfort [ 5 – 7 ]. The 25-gauge platform popularized sutureless PPV [ 5 ], while 23-gauge offered greater instrument rigidity at the cost of slightly larger wounds [ 6 ]. The advent of 27-gauge systems by Oshima and colleagues further miniaturized access, promising smaller sclerotomies, reduced conjunctival manipulation, and potentially less inflammation and hypotony [ 7 ]. Nevertheless, downsizing instruments introduces trade-offs: thinner shafts may be more flexible, flow rates can be lower, and fine tissue manipulation (especially during ERM–ILM peeling) may be more sensitive to deflection and torque, occasionally necessitating instrument changes that could lengthen procedures [ 7 – 9 ]. Comparative clinical data on 25G versus 27G in ERM surgery have expanded. A randomized trial reported longer vitrectomy time with 27G but similar visual and anatomic outcomes versus 25G [ 10 ]. Large retrospective cohorts and prospective series likewise found that total operative time is often modestly longer with 27G, whereas best-corrected visual acuity (BCVA), central macular thickness (CMT), intraocular pressure (IOP), and complication profiles are broadly similar between gauges [ 8 , 9 , 11 – 13 ]. Patient-reported outcomes after ERM surgery also improve substantially and appear independent of gauge size when surgery is technically successful [ 14 ]. Despite this growing literature, several limitations persist. Many studies mix multiple indications (e.g., ERM and full-thickness macular hole), involve multiple surgeons, or lack standardized platforms and detailed time component analysis (e.g., core vitrectomy vs peeling time), which obscures mechanistic understanding of where time differences arise [ 11 , 13 ]. Moreover, few reports prospectively quantify intraoperative instrument changes (e.g., additional light probes or cutters) as potential contributors to workflow interruptions and extended operating time [ 8 , 9 ]. Against this backdrop, we designed a single-surgeon study to minimize heterogeneity, employing a uniform surgical platform and standardized timing of key procedural steps including core vitrectomy, ERM–ILM peeling, and total surgical duration, alongside documentation of intraoperative instrument changes. The primary aim was to compare 27G and 25G vitrectomy in terms of visual and anatomical outcomes at 12 months, while systematically assessing operative times. We further hypothesized that potential differences could be related to gauge-specific instrument characteristics, such as shaft rigidity and flexibility, which may also influence the likelihood of intraoperative instrument replacement. Materials and methods This retrospective, observational cohort included consecutive eyes that underwent pars plana vitrectomy (PPV) for idiopathic epiretinal membrane (ERM) at Tekirdağ Namık Kemal University Hospital between March 2021 and January 2023. The protocol adhered to the Declaration of Helsinki and received institutional approval (Ethics No. 2022.194.10.18); written informed consent had been obtained preoperatively. Eligibility required an OCT- and biomicroscopy-confirmed diagnosis of idiopathic ERM and a minimum of 12 months of follow-up; eyes with prior vitrectomy, diabetic retinopathy or retinal vascular occlusion, glaucoma or uveitis, or a history of complicated corneal/cataract surgery were excluded. When both eyes were eligible, the first operated eye was analyzed. Gauge allocation reflected routine practice, and eyes were classified as 25G or 27G. All operations were performed by the same experienced, right-handed vitreoretinal surgeon (E.Ç.) on a uniform platform (EVA NEXUS, DORC, The Netherlands) using VacuFlow VTi fluidics and a two-dimensional cutting (TDC) vitrector. Surgery was performed under sub-Tenon anesthesia (total 3 mL: 0.75% bupivacaine and 2% lidocaine with adrenaline). Three tunneled transconjunctival sclerotomies were created (inferotemporal first, then superonasal and superotemporal) introducing trocars at ~ 30° to the sclera before directing them perpendicularly. Macular visualization was achieved using a high-magnification contact lens (Super Central Macula, Volk Optical Inc., USA). In phakic eyes, 2.4-mm micro-coaxial phacoemulsification with IOL implantation was performed during the same session; the main corneal incision was temporarily secured with a 10 − 0 nylon suture, which was removed at the conclusion of surgery. After core vitrectomy with the assigned gauge, the posterior hyaloid was verified and detached if still adherent. The macular surface was inspected at low aspiration and low flow to identify microfolds and a cleavage plane. A diamond-dusted sweeper was used to tease the epiretinal surface and to create a small flap away from the foveal center. A membrane edge was then grasped with gauge-matched micro-forceps and the ERM was peeled in a slow continuous motion. The peel proceeded in a circular or spiral fashion to minimize traction on the fovea and to keep the traction vector tangential to the macula. Small hemorrhages were managed by brief elevation of infusion pressure and the field was re-inspected before moving to the next quadrant. Once the ERM had been removed, the internal limiting membrane was peeled in a contiguous area centered on the fovea, typically spanning approximately two to three disc diameters. The ILM edge was initiated using the diamond-dusted sweeper or by a gentle pinch-and-peel with micro-forceps, and the membrane was removed as a continuous sheet whenever possible. Aspiration and light intensity were kept at the lowest levels that preserved a stable view. Instrument movements were short and controlled to avoid vertical vectoring. The macula was examined at the end of peeling to confirm the absence of residual membranes and to exclude iatrogenic retinal breaks. A gas tamponade with sulfur hexafluoride (SF₆) was applied in all cases to provide internal tamponade and to support early retinal stabilization. At the conclusion of surgery, all sclerotomies were gently massaged to achieve self-sealing and were left sutureless once the absence of leakage was confirmed, physiologic intraocular pressure was verified by digital palpation, and a sub-Tenon injection of gentamicin–dexamethasone was administered. Postoperative therapy comprised topical moxifloxacin and prednisolone acetate (each 6×/day) and tropicamide (3×/day). As SF₆ gas was used in all cases, patients were advised to maintain face-down positioning up to 16 hours/day during the first postoperative week. Examinations were scheduled preoperatively and at postoperative day 1, week 1, and months 1, 3, 6, and 12. Outcomes included BCVA (logMAR), IOP by Goldmann applanation tonometer, and CMT measured on the same OCT device for all eyes (Cirrus 6000 HD-OCT; Carl Zeiss Meditec, Germany). Because early OCT can be confounded by intraocular gas, CMT was analyzed from month 1 onward. Operative timing comprised: total surgical time (from initiation of sub-Tenon anesthesia to completion of the final sub-Tenon antibiotic–steroid injection), core vitrectomy time (cumulative cutter-on time during central vitrectomy), and ERM–ILM peeling time (from initiation to completion of peeling). Intraoperative hemorrhage and other complications were recorded. Instrument utilization was prospectively noted as the number of light probes and vitrectomy cutters used (single vs ≥ 2). Presence of metamorphopsia at month 12 was assessed with an Amsler grid (present/absent). The primary outcomes were total surgical time, core vitrectomy time, and ERM–ILM peeling time; secondary outcomes were BCVA, IOP, and CMT values up to month 12, 12-month metamorphopsia, and intraoperative instrument changes/complications. Demographics (age, sex), lens status (phakic/pseudophakic), gauge group, and all outcome data were extracted into a standardized database; only eyes with complete 12-month data were included (complete-case analysis, no imputation). Cases in which intraoperative complications that could prolong surgical time occurred, such as intraocular hemorrhage, retinal detachment, intraocular lens dislocation, or posterior capsule rupture, were excluded from the study. Statistical analysis Continuous variables were summarized as mean ± standard deviation and median (range), and categorical variables as counts and percentages. Normality was assessed using Kolmogorov–Smirnov and Shapiro–Wilk tests. Between-group comparisons employed the Mann–Whitney U test for continuous/non-normally distributed data and χ² or Fisher’s exact tests for categorical data, as appropriate. All tests were two-sided with a significance threshold of P < 0.05. Analyses were performed with SPSS version 27.0 (IBM Corp., Armonk, NY, USA). Results A total of 107 eyes met inclusion criteria and were analyzed (27G, n = 68; 25G, n = 39). The mean age was 64.6 ± 7.9 years (range, 50–83) and 55.1% were male (Table 1 ). Baseline characteristics were balanced between groups with no differences in age, sex, or lens status (all P > 0.05). Functional (BCVA) and anatomic (CMT) outcomes showed similar longitudinal trends between the 25G and 27G groups throughout follow-up. BCVA showed the expected immediate postoperative decline at day 1 followed by progressive improvement, with no between-group differences at any visit from baseline through month 12 (all P > 0.05; Table 1 ; Fig. 1 ). Intraoperative instrument use was also comparable: the proportion requiring ≥ 2 light probes and the proportion requiring ≥ 2 vitrectomy cutters did not differ between 27G and 25G (light probe: P = 0.300; cutter: P = 0.651; Table 1 ). Table 1 Comparison of demographic characteristics, surgical parameters, and postoperative outcomes between 27-gauge and 25-gauge pars plana vitrectomy groups. 27 Gauge (n = 68) 25 Gauge (n = 39) p Mean ± SD / n-% Median Mean ± SD / n-% Median Age 63.6 ± 8.0 66.0 66.2 ± 7.5 66.0 0.207 (m) Sex Female 26 / 38.2% 22 / 56.4% 0.069 (X²) Male 42 / 61.8% 17 / 43.6% Lens Status Phakic 52 / 76.5% 34 / 87.2% 0.179 (X²) Pseudophakic 16 / 23.5% 5 / 12.8% Light Probe Used 1 63 / 92.6% 38 / 97.4% 0.300 (X²) ≥ 2 5 / 7.4% 1 / 2.6% Vitrectomy Probe Used 1 64 / 94.1% 38 / 97.4% 0.651 (X²) ≥ 2 4 / 5.9% 1 / 2.6% Surgical Times (min) ERM-ILM Peel Time 8.1 ± 2.2 8.0 9.4 ± 2.5 10.0 0.073 (m) Core Time 27.8 ± 10.8 26.5 21.8 ± 9.1 22.0 0.014 (m) Total Time 45.6 ± 9.4 43.0 38.1 ± 10.4 43.0 0.001 (m) m: Mann–Whitney U test, X²: Chi-square or Fisher’s exact test [ Insert Fig. 1 ] Figure 1 . BCVA (logMAR) at baseline and follow-up visits in the 27G and 25G groups. Both groups showed an early postoperative decline followed by progressive improvement, with no significant differences at any time point. IOP likewise did not differ between groups at any time point (all P > 0.05; Table 2 ). CMT showed a significant postoperative decrease in both gauge groups. Due to the presence of SF₆ gas occupying more than half of the vitreous cavity on postoperative day 1, reliable OCT imaging could not be obtained at that time in most eyes. Furthermore, gas resorption was still ongoing during the first postoperative week, and thus OCT was not available for all cases at that point. However, by the first postoperative month, complete CMT data were available for the entire cohort, allowing for robust comparison. At this time point, both groups demonstrated a marked reduction in CMT, reflecting the early anatomic response to ERM–ILM peeling. This reduction continued steadily until month 3, after which CMT values stabilized in both groups. No statistically significant differences in CMT were detected between the 27G and 25G groups at months 1, 3, 6, or 12, indicating similar anatomical recovery profiles across gauge types (all P > 0.05; Table 2 ; Fig. 2 ). At month 12, metamorphopsia was reported by 52.9% of 27G eyes and 41.0% of 25G eyes, a difference that was not statistically significant ( P = 0.235; Table 2 ). Table 2 Postoperative changes in best-corrected visual acuity, intraocular pressure, central macular thickness, and presence of metamorphopsia in the 27-gauge and 25-gauge groups. 27 Gauge (n = 68) 25 Gauge (n = 39) p Mean ± SD Median Mean ± SD Median BCVA (LogMAR) Preop 0.6 ± 0.4 0.5 0.7 ± 0.4 0.7 0.277 (m) Postop Day 1 1.7 ± 0.3 1.1 1.6 ± 0.3 1.6 0.054 (m) Week 1 1.1 ± 0.4 1.3 1.1 ± 0.4 1.3 0.922 (m) Month 1 0.3 ± 0.2 0.2 0.2 ± 0.2 0.2 0.697 (m) Month 3 0.2 ± 0.1 0.2 0.2 ± 0.2 0.2 0.997 (m) Month 6 0.2 ± 0.1 0.2 0.2 ± 0.2 0.2 0.840 (m) Month 12 0.2 ± 0.1 0.2 0.2 ± 0.1 0.2 0.606 (m) IOP (mmHg) Preop 13.7 ± 2.7 14.0 13.5 ± 2.8 14.0 0.862 (m) Postop Day 1 15.2 ± 5.0 15.0 13.6 ± 5.0 14.0 0.080 (m) Week 1 14.4 ± 2.4 15.0 15.2 ± 2.8 15.0 0.320 (m) Month 1 14.8 ± 2.2 15.0 14.4 ± 2.2 14.0 0.328 (m) Month 3 15.0 ± 2.3 15.0 14.5 ± 2.4 14.0 0.279 (m) Month 6 15.2 ± 2.5 15.0 14.4 ± 2.5 14.0 0.070 (m) Month 12 15.1 ± 2.4 15.0 14.5 ± 2.3 14.0 0.208 (m) CMT (µm) Preop 429.1 ± 73.1 412.0 420.9 ± 67.2 401.0 0.729 (m) Postop Month 1 362.8 ± 50.2 360.0 370.6 ± 47.0 363.0 0.380 (m) Month 3 371.6 ± 42.2 364.0 354.3 ± 46.3 356.0 0.053 (m) Month 6 354.4 ± 37.2 355.0 355.1 ± 40.2 360.0 0.838 (m) Month 12 351.9 ± 31.6 352.0 358.1 ± 29.5 355.0 0.416 (m) Metamorphopsia Postop Month 12 36 / 52.9% 16 / 41.0% 0.235 (X²) BCVA: best-corrected visual acuity; CMT: central macular thickness; IOP: intraocular pressure; LogMAR: logarithm of the minimum angle of resolution; SD: standard deviation; Med: median; µm: micrometer; m: Mann–Whitney U test, X²: Chi-square or Fisher’s exact test [ Insert Fig. 2 ] Figure 2 . Change in central macular thickness (CMT) over time in the 27G and 25G groups. Both groups demonstrated a marked reduction postoperatively, with sustained improvements throughout follow-up and no intergroup differences. Regarding surgical performance metrics, ERM–ILM peel duration was longer in the 25G group than in the 27G group (9.4 ± 2.5 vs 8.1 ± 2.2 minutes; P = 0.073), whereas both core vitrectomy time and total surgical time were longer with 27G (core: 27.8 ± 10.8 vs 21.8 ± 9.1 minutes, P = 0.014; total: 45.6 ± 9.4 vs 38.1 ± 10.4 minutes, P = 0.001; Table 1 ). The broader dispersion and right-shift of core times in the 27G cohort are visualized in Fig. 3 , which also depicts the distribution of total surgery times. [ Insert Fig. 3 ] Figure 3 . Dot plots illustrating operative durations. (Left) Distribution of core vitrectomy times in the 25G and 27G groups. (Right) Distribution of total surgery times. Both operative parameters were significantly longer in the 27G group compared with the 25G group (core time, P = 0.014; total time, P = 0.001). Discussion Transconjunctival microincision vitrectomy has progressively shifted from 20G to 27G with the aim of reducing complications and enhancing early postoperative comfort. In idiopathic ERM surgery, both 25G and 27G approaches have been widely adopted and shown to yield similar visual, functional, and anatomical outcomes [ 8 , 9 , 15 – 17 ]. However, reports diverge on intraoperative ease and duration, with some series describing longer vitrectomy segments and total operating times with 27G, while others note minimal or step-specific differences limited to core removal or peeling [ 8 , 9 , 15 , 16 ]. In our study, both BCVA and CMT improved postoperatively in a statistically and clinically similar manner in the 27G and 25G groups, suggesting that functional and anatomical recovery was not influenced by gauge size. These results are in alignment with the current evidence from most comparative studies on idiopathic ERM surgery, which consistently demonstrate that postoperative outcomes remain effective and reproducible across different vitrectomy gauge systems [ 10 , 15 , 16 , 18 , 19 ]. Following an effective vitrectomy and meticulous ERM–ILM peeling, visual acuity showed a progressive postoperative improvement that paralleled the anatomical recovery, as evidenced by a continuous reduction in central macular thickness [ 20 – 23 ]. The resolution of tangential traction enables the restoration of foveal contour, reduction of inner retinal thickening and microfolds, and gradual reorganization of the outer retinal layers. Among these structural parameters, the integrity of the ellipsoid zone and the external limiting membrane has been shown to correlate closely with postoperative visual improvement [ 21 – 23 ]. In our series, the transient decline in visual acuity observed on postoperative day 1, along with the inability to obtain reliable CMT measurements during the early postoperative period, was primarily attributable to the presence of intraocular gas, which obstructed the visualization of the posterior segment and interfered with OCT signal acquisition [ 8 , 24 ]. As the gas gradually resorbed, BCVA improved markedly and CMT became measurable, with the decrease in thickness closely accompanying the functional recovery [ 20 , 22 , 23 ]. Notably, anatomical and visual improvement was already apparent by the first postoperative month in both gauge groups and continued to progress in logMAR terms. However, from month 3 through month 12, both BCVA and CMT values remained stable, without any statistically significant difference between the 27G and 25G groups [ 15 , 16 , 22 ]. Although small numerical differences in CMT were observed between the two groups at months 3, 6, and 12, none of these reached statistical significance. This eventual anatomical convergence is consistent with previous ERM literature, which shows that macular remodeling typically stabilizes by 3 to 6 months postoperatively, even though some patients may continue to experience gradual functional adaptation thereafter [ 15 , 16 , 22 , 23 ]. Metamorphopsia persisted in approximately half of eyes at month 12, with no between-group difference. This rate is consistent with prior literature underscoring that symptomatic distortion can outlast anatomic normalization, likely reflecting inner retinal remodeling and protracted cortical adaptation rather than incomplete membrane removal per se [ 14 ]. The lack of a gauge effect here reinforces that final subjective vision is more tightly tied to preoperative microstructure of the retina and completeness of peel than to cannula diameter. In small-gauge transconjunctival PPV, early postoperative IOP can vary with trocar entry architecture, sclerotomy diameter, oblique/tunneled wound construction, and the use or omission of sutures [ 6 , 7 , 25 ]. In our study, day-1 IOP values showed a wide distribution. IOP was similar between groups, and no clinically significant hypotony or ocular hypertension was observed on postoperative day 1. In both groups, all three ports were left sutureless after gentle external massage and controlled venting of residual gas, and physiologic tone was confirmed intraoperatively by digital palpation. This standardized closure was associated with the absence of early pressure extremes; the broad day-1 spread likely reflects variable gas fill, transient wound apposition dynamics, and physiologic fluctuation (see Table 2 ). Across follow-up, IOP remained stable, and no visit showed a statistically significant difference between the 25G and 27G groups; these findings are consistent with comparative series reporting similar pressure profiles across gauges [ 8 , 9 , 15 , 16 ]. Contemporary small-incision techniques employing angled/tunneled sclerotomies and smaller port diameters may further mitigate clinically relevant hypotony and support early pressure stability, which is consistent with our results [ 6 , 7 , 25 ]. Operative timing in our analysis showed a step-specific divergence between gauges. Core vitrectomy and total surgical duration were longer with 27G, whereas ERM–ILM peeling tended to take longer with 25G. The most direct explanation lies in vitrectomy fluidics and instrument mechanics. The wider lumen of 25G permits greater vitreous throughput per unit time, which accelerates core removal even when cut rates are matched. The stiffer 25G shaft resists bending, so the cutter tracks more predictably during broad sweeps of the mid-vitreous and requires fewer micro-corrections. By contrast, the narrower 27G lumen limits volumetric flow and the more flexible shaft is susceptible to small deflections, which slows evacuation and introduces brief pauses for repositioning despite modern platforms [ 7 , 8 ]. In our series, bending events and intraoperative exchanges of light probes or cutters were numerically more frequent with 27G, but the difference was not statistically significant, which suggests that micro-interruptions contribute to the observed timing yet are not the sole driver. The concentration of delay in the core vitrectomy segment propagated to a longer total case time in the 27G group, a pattern that mirrors reports describing extended vitrectomy or overall times with 27G in ERM surgery while long-term outcomes remain similar between gauges [ 10 – 12 ]. Other studies have shown minimal differences or context-dependent results, likely reflecting platform and case-mix variation, yet the prevailing signal favors a small time penalty for 27G core work under routine conditions [ 9 , 13 ]. Bench-top and intraoperative observations indicate that 27G instruments have lower bending stiffness and are more prone to deflection or tip deformation under load, particularly with oblique trocar trajectories or during anterior maneuvers [ 7 , 8 ]. Our timing data are consistent with this behavior and suggest that even when exchanges are infrequent, the small pauses and reorientations imposed by flexibility accumulate and lengthen overall operating time. By contrast, peeling took longer with 25G in our series. A plausible explanation is that greater shaft rigidity, while transmitting force efficiently, affords less compliance at the instrument tip during close-quarters maneuvers on the macula. The slightly more flexible 27G forceps and sweepers may permit smoother micro-adjustments, fewer regrasping attempts, and steadier traction vectors once a flap is initiated, which shortens the sequence of peel–release–reposition cycles [ 9 , 17 ]. Consistent with this interpretation, a randomized comparison reported no disadvantage to 27G for ERM–ILM peeling time, and other series have described equal or faster peeling with 27G despite similar long-term outcomes between gauges [ 9 , 10 , 12 ]. Taken together, these observations suggest that any gauge effect on peeling is small and often overshadowed by technique and case complexity, whereas the more pronounced timing difference resides in the core segment driven by gauge-dependent fluidics. This study benefits from a uniform indication, a single surgical platform and step-specific timing performed by one surgeon, which reduced variability. The retrospective design and nonrandom gauge allocation remain limitations. The sample size was modest for rare intraoperative events, and metamorphopsia was assessed with an Amsler grid. Early OCT was limited in gas-filled eyes, which prevented ultra-acute CMT assessment. These factors may have attenuated sensitivity to small differences. Future prospective studies on standardized platforms will help define how instrumentation and technique modulate the observed timing effects. In summary, our data indicate that 25G and 27G deliver similar visual and anatomical outcomes, while operative efficiency differs in a gauge-dependent and step-specific manner. The time penalty with 27G is concentrated in the core vitrectomy and carries through to the total case duration, whereas any difference during peeling is small and variable. These patterns are consistent with differences in lumen size, flow and shaft behavior, and they highlight the value of tailoring technique to the chosen gauge. Surgeons can optimize trocar trajectory, infusion settings and instrument choice to reduce micro-delays and streamline the core segment. Gauge choice can therefore be aligned with priorities such as throughput, wound micro-trauma and postoperative comfort rather than expectations of different long-term endpoints. As the study was conducted retrospectively using anonymized data obtained from routine clinical examinations and surgical procedures, the requirement for informed consent was formally waived by the ethics committee. No additional interventions were performed, and no identifiable patient information was used. Declarations Ethics approval and consent to participate This study was approved by the Clinical Research Ethics Committee of Tekirdağ Namık Kemal University (Approval No: 2022.194.10.18). The study adhered to the tenets of the Declaration of Helsinki. Written informed consent was obtained from all patients prior to surgery. Consent for publication Not applicable. Competing interests The authors declare that they have no competing interests. Funding The authors received no external funding for this research. Author Contribution Ekrem Celik: Conceptualization, surgical procedures, data curation, literature review, statistical analysis, and critical revision of the manuscript; Evrim Polat: Literature review, statistical analysis, figure preparation, and manuscript drafting. Both authors read and approved the final manuscript. Acknowledgements Not applicable. Data availability The datasets generated and/or analyzed during the current study are available from the corresponding author on reasonable request. References Fung AT, Galvin J, Tran T. Epiretinal membrane: a review. Clin Exp Ophthalmol. 2021;49(6):712–29. Xiao W, Chen X, Yan W, et al. Prevalence and risk factors of epiretinal membranes: a systematic review and meta-analysis. Clin Exp Ophthalmol. 2020;48(8):1048–61. Englmaier V, et al. Short-term outcomes of idiopathic epiretinal membranes following pars plana vitrectomy with ERM–ILM peeling. BMC Ophthalmol. 2023;23:496. Kanai M, et al. Long-term risk factors for poor visual outcomes in pars plana vitrectomy with ERM peeling. Sci Rep. 2024;14:80020. Fujii GY, De Juan E Jr, Humayun MS, et al. A new 25-gauge instrument system for transconjunctival sutureless microincision vitrectomy surgery. Ophthalmology. 2002;109(10):1807–12. Eckardt C. Transconjunctival sutureless 23-gauge vitrectomy. Retina. 2005;25(2):208–11. Oshima Y, Wakabayashi T, Sato T, Ohji M, Tano Y. A 27-gauge instrument system for transconjunctival sutureless microincision vitrectomy surgery. Ophthalmology. 2010;117(1):93–e1022. Shimada H, Nakashizuka H, Hattori T, Mori R, Mizutani Y. 27-gauge vitrectomy versus 25-gauge vitrectomy for idiopathic epiretinal membrane. Retina. 2018;38(2):299–307. Nagpal M, Mehrotra N, Juneja R, Jain P. 27-Gauge vitrectomy system for epiretinal membrane surgery: comparison of surgical outcomes and complications with 25-Gauge system. Retina. 2018;38(Suppl 1):S45–50. Mitsui K, Kogo J, Takeda H, et al. Comparison of 25-gauge and 27-gauge vitrectomy for idiopathic epiretinal membrane. J Ophthalmol. 2017;2017:5672742. Naruse S, Shimada H, Mori R. 27-gauge and 25-gauge vitrectomy day surgery for idiopathic epiretinal membrane. BMC Ophthalmol. 2017;17:188. Lubiński W, Podborączyńska-Jodko K, Penkala K, Post M, Mrukwa-Kominek E. 25G versus 27G vitrectomy for idiopathic epiretinal membrane removal: a prospective randomized trial. Ophthalmol J. 2022;7(3):211–7. Brown GC, et al. Vitrectomy instrumentation comparison: 25G vs 27G for macular disease. Retina Today. 2020;15(2):35–40. Okamoto F, Okamoto Y, Fukuda S, Hiraoka T, Oshika T. Vision-related quality of life and visual function after pars plana vitrectomy for epiretinal membrane. PLoS ONE. 2015;10(6):e0128011. Ohta T, Inoue M, Shinoda K, et al. Comparative study of 25- and 27-gauge vitrectomy for idiopathic epiretinal membrane. Retina. 2014;35(11):2317–21. Liu Y, Zeng Y, Ma J, et al. Comparison of anatomical and functional outcomes after 25-G and 27-G vitrectomy for idiopathic epiretinal membrane. BMC Ophthalmol. 2022;22(1):53. Hikichi T, Fujio N, Akiba J. Comparison of postoperative outcomes between 25-gauge and 27-gauge vitrectomy for idiopathic epiretinal membrane. J Clin Exp Ophthalmol. 2017;8(1):1000643. Karimi S, Entezari M, Feizi M, et al. Comparing outcomes of 27-gauge and 25-gauge vitrectomy in the treatment of idiopathic epiretinal membrane. Int J Retina Vitreous. 2020;6:11. Narayanan R, Singh SR, Taylor S, Berrocal MH. Outcomes of 25-gauge versus 27-gauge pars plana vitrectomy for macular surgery: a systematic review and meta-analysis. Indian J Ophthalmol. 2023;71(6):2219–27. Ozturker C, Karabas L, Cakir B, et al. Relationship between central macular thickness and visual acuity improvement after epiretinal membrane surgery. Int J Ophthalmol. 2018;11(6):1022–6. Yang HS, Lee JH, Kim JW, et al. Correlation between spectral-domain optical coherence tomography findings and visual acuity after surgery for idiopathic epiretinal membrane. Retina. 2013;33(9):1791–7. Ripandelli G, Coppe AM, Parisi V, et al. Functional and anatomical changes following epiretinal membrane surgery: a follow-up study. Graefes Arch Clin Exp Ophthalmol. 2015;253(1):47–56. Romano MR, Comune C, Ferrara M, et al. Evaluation of anatomical and functional outcomes using spectral-domain optical coherence tomography in idiopathic epiretinal membranes. Graefes Arch Clin Exp Ophthalmol. 2011;249(10):1465–70. Sandali O, El Sanharawi M, Paraf F, et al. Epiretinal membrane surgery: safety and functional outcomes in young and older patients. Graefes Arch Clin Exp Ophthalmol. 2010;248(3):305–11. Khan MA, Shahlaee A, Toussaint B, Kuriyan AE, Valikodath NG, Hsu J, et al. Outcomes of 27-gauge microincision vitrectomy surgery for posterior segment disease. Br J Ophthalmol. 2016;100(7):939–43. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Reviews received at journal 22 Apr, 2026 Reviews received at journal 06 Apr, 2026 Reviewers agreed at journal 01 Apr, 2026 Reviewers agreed at journal 08 Mar, 2026 Reviewers invited by journal 14 Oct, 2025 Editor invited by journal 09 Oct, 2025 Editor assigned by journal 07 Oct, 2025 Submission checks completed at journal 07 Oct, 2025 First submitted to journal 07 Oct, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7802678","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":534301647,"identity":"9311cefe-4fcc-4213-9cc2-599b6989a928","order_by":0,"name":"Ekrem Celik","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAyElEQVRIiWNgGAWjYDACHiB+YJAgB2IfeEC0lgSDBGOwlgTitTAkJDYwgBlEAH6eww8fJBSkpc8PO/wQaIudnG4DAS2SvW3GBgkGObkbb6cZALUkG5sdIKDF4DwPm0SCQUXuxtkJIC0HErcR0mJ/nof9B1BLuuHs9A/EaTHg7WEDhlhOgrx0DpG2SJw5Zgx0WJrhBumcggMJBkT4hb8n+eGHD3+S5eVnp2/+8KHCTo6gFoQLwSoNiFUOAvINpKgeBaNgFIyCEQUADcREv4Geq/0AAAAASUVORK5CYII=","orcid":"","institution":"Olgun Eye Medical Center","correspondingAuthor":true,"prefix":"","firstName":"Ekrem","middleName":"","lastName":"Celik","suffix":""},{"id":534301650,"identity":"a4792062-a38e-4479-a034-1276376a52cf","order_by":1,"name":"Evrim Polat","email":"","orcid":"","institution":"Istanbul Training and Research Hospital","correspondingAuthor":false,"prefix":"","firstName":"Evrim","middleName":"","lastName":"Polat","suffix":""}],"badges":[],"createdAt":"2025-10-07 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04:18:34","extension":"html","order_by":21,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":124831,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7802678/v1/526b5d47c309c29987c2cfc0.html"},{"id":94622882,"identity":"3849fe64-6654-4873-88b1-68f75347c57f","added_by":"auto","created_at":"2025-10-29 04:18:37","extension":"jpeg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":301307,"visible":true,"origin":"","legend":"\u003cp\u003eBCVA (logMAR) at baseline and follow-up visits in the 27G and 25G groups. Both groups showed an early postoperative decline followed by progressive improvement, with no significant differences at any time point.\u003c/p\u003e","description":"","filename":"Figure1BCVA300dpi.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-7802678/v1/328a419f39bbf5c79ad6eabd.jpeg"},{"id":94622441,"identity":"39670d60-159e-4fca-9bf0-fe8c25bb9c78","added_by":"auto","created_at":"2025-10-29 04:18:19","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":222338,"visible":true,"origin":"","legend":"\u003cp\u003eChange in central macular thickness (CMT) over time in the 27G and 25G groups. Both groups demonstrated a marked reduction postoperatively, with sustained improvements throughout follow-up and no intergroup differences.\u003c/p\u003e","description":"","filename":"Figure2CMT300dpi.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7802678/v1/107654b331a0f0de49351ce8.jpg"},{"id":94622693,"identity":"3c57a4df-3b34-46d9-9e51-588ed99f8f84","added_by":"auto","created_at":"2025-10-29 04:18:28","extension":"jpeg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":292251,"visible":true,"origin":"","legend":"\u003cp\u003eDot plots illustrating operative durations. (Left) Distribution of core vitrectomy times in the 25G and 27G groups. (Right) Distribution of total surgery times. Both operative parameters were significantly longer in the 27G group compared with the 25G group (core time, P = 0.014; total time, P = 0.001).\u003c/p\u003e","description":"","filename":"Figure3DotPlots300dpi.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-7802678/v1/a402b13f242e9fc951055f29.jpeg"},{"id":94640047,"identity":"c5d0ae31-5a4e-4d1f-8f4c-6f3c13a8f518","added_by":"auto","created_at":"2025-10-29 07:48:02","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1797969,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7802678/v1/182181f4-b09b-43b6-95d1-af826723c354.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"25- Versus 27-Gauge Vitrectomy for Idiopathic Epiretinal Membrane: Operative Time and Outcomes in a Homogeneous Cohort","fulltext":[{"header":"Introduction","content":"\u003cp\u003eIdiopathic epiretinal membrane (ERM) is a prevalent macular disorder whose incidence rises sharply with advancing age-reported prevalences include approximately 7.2% in individuals aged 60\u0026ndash;69 years and up to 11.6\u0026ndash;12% among those aged 70 years and older [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Though often asymptomatic in its early stages, ERM commonly presents with central visual distortion and metamorphopsia, significantly impacting daily life in elderly patients. When such functional impairment becomes clinically relevant, pars plana vitrectomy (PPV) combined with ERM\u0026ndash;ILM peeling stands as the standard surgical treatment and has demonstrated favorable visual and anatomical outcomes [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Over the last two decades, the shift toward transconjunctival microincision vitrectomy surgery (MIVS) has progressively reduced incision size from 23-gauge to 25-gauge and, more recently, to 27-gauge, with the aims of minimizing surgical trauma, accelerating wound sealing, and improving early postoperative comfort [\u003cspan additionalcitationids=\"CR6\" citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe 25-gauge platform popularized sutureless PPV [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e], while 23-gauge offered greater instrument rigidity at the cost of slightly larger wounds [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. The advent of 27-gauge systems by Oshima and colleagues further miniaturized access, promising smaller sclerotomies, reduced conjunctival manipulation, and potentially less inflammation and hypotony [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Nevertheless, downsizing instruments introduces trade-offs: thinner shafts may be more flexible, flow rates can be lower, and fine tissue manipulation (especially during ERM\u0026ndash;ILM peeling) may be more sensitive to deflection and torque, occasionally necessitating instrument changes that could lengthen procedures [\u003cspan additionalcitationids=\"CR8\" citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eComparative clinical data on 25G versus 27G in ERM surgery have expanded. A randomized trial reported longer vitrectomy time with 27G but similar visual and anatomic outcomes versus 25G [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Large retrospective cohorts and prospective series likewise found that total operative time is often modestly longer with 27G, whereas best-corrected visual acuity (BCVA), central macular thickness (CMT), intraocular pressure (IOP), and complication profiles are broadly similar between gauges [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan additionalcitationids=\"CR12\" citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Patient-reported outcomes after ERM surgery also improve substantially and appear independent of gauge size when surgery is technically successful [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eDespite this growing literature, several limitations persist. Many studies mix multiple indications (e.g., ERM and full-thickness macular hole), involve multiple surgeons, or lack standardized platforms and detailed time component analysis (e.g., core vitrectomy vs peeling time), which obscures mechanistic understanding of where time differences arise [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Moreover, few reports prospectively quantify intraoperative instrument changes (e.g., additional light probes or cutters) as potential contributors to workflow interruptions and extended operating time [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eAgainst this backdrop, we designed a single-surgeon study to minimize heterogeneity, employing a uniform surgical platform and standardized timing of key procedural steps including core vitrectomy, ERM\u0026ndash;ILM peeling, and total surgical duration, alongside documentation of intraoperative instrument changes. The primary aim was to compare 27G and 25G vitrectomy in terms of visual and anatomical outcomes at 12 months, while systematically assessing operative times. We further hypothesized that potential differences could be related to gauge-specific instrument characteristics, such as shaft rigidity and flexibility, which may also influence the likelihood of intraoperative instrument replacement.\u003c/p\u003e"},{"header":"Materials and methods","content":"\u003cp\u003eThis retrospective, observational cohort included consecutive eyes that underwent pars plana vitrectomy (PPV) for idiopathic epiretinal membrane (ERM) at Tekirdağ Namık Kemal University Hospital between March 2021 and January 2023. The protocol adhered to the Declaration of Helsinki and received institutional approval (Ethics No. 2022.194.10.18); written informed consent had been obtained preoperatively. Eligibility required an OCT- and biomicroscopy-confirmed diagnosis of idiopathic ERM and a minimum of 12 months of follow-up; eyes with prior vitrectomy, diabetic retinopathy or retinal vascular occlusion, glaucoma or uveitis, or a history of complicated corneal/cataract surgery were excluded. When both eyes were eligible, the first operated eye was analyzed. Gauge allocation reflected routine practice, and eyes were classified as 25G or 27G. All operations were performed by the same experienced, right-handed vitreoretinal surgeon (E.\u0026Ccedil;.) on a uniform platform (EVA NEXUS, DORC, The Netherlands) using VacuFlow VTi fluidics and a two-dimensional cutting (TDC) vitrector.\u003c/p\u003e\u003cp\u003eSurgery was performed under sub-Tenon anesthesia (total 3 mL: 0.75% bupivacaine and 2% lidocaine with adrenaline). Three tunneled transconjunctival sclerotomies were created (inferotemporal first, then superonasal and superotemporal) introducing trocars at ~\u0026thinsp;30\u0026deg; to the sclera before directing them perpendicularly. Macular visualization was achieved using a high-magnification contact lens (Super Central Macula, Volk Optical Inc., USA). In phakic eyes, 2.4-mm micro-coaxial phacoemulsification with IOL implantation was performed during the same session; the main corneal incision was temporarily secured with a 10\u0026thinsp;\u0026minus;\u0026thinsp;0 nylon suture, which was removed at the conclusion of surgery. After core vitrectomy with the assigned gauge, the posterior hyaloid was verified and detached if still adherent. The macular surface was inspected at low aspiration and low flow to identify microfolds and a cleavage plane. A diamond-dusted sweeper was used to tease the epiretinal surface and to create a small flap away from the foveal center. A membrane edge was then grasped with gauge-matched micro-forceps and the ERM was peeled in a slow continuous motion. The peel proceeded in a circular or spiral fashion to minimize traction on the fovea and to keep the traction vector tangential to the macula. Small hemorrhages were managed by brief elevation of infusion pressure and the field was re-inspected before moving to the next quadrant. Once the ERM had been removed, the internal limiting membrane was peeled in a contiguous area centered on the fovea, typically spanning approximately two to three disc diameters. The ILM edge was initiated using the diamond-dusted sweeper or by a gentle pinch-and-peel with micro-forceps, and the membrane was removed as a continuous sheet whenever possible. Aspiration and light intensity were kept at the lowest levels that preserved a stable view. Instrument movements were short and controlled to avoid vertical vectoring. The macula was examined at the end of peeling to confirm the absence of residual membranes and to exclude iatrogenic retinal breaks. A gas tamponade with sulfur hexafluoride (SF₆) was applied in all cases to provide internal tamponade and to support early retinal stabilization. At the conclusion of surgery, all sclerotomies were gently massaged to achieve self-sealing and were left sutureless once the absence of leakage was confirmed, physiologic intraocular pressure was verified by digital palpation, and a sub-Tenon injection of gentamicin\u0026ndash;dexamethasone was administered.\u003c/p\u003e\u003cp\u003ePostoperative therapy comprised topical moxifloxacin and prednisolone acetate (each 6\u0026times;/day) and tropicamide (3\u0026times;/day). As SF₆ gas was used in all cases, patients were advised to maintain face-down positioning up to 16 hours/day during the first postoperative week. Examinations were scheduled preoperatively and at postoperative day 1, week 1, and months 1, 3, 6, and 12. Outcomes included BCVA (logMAR), IOP by Goldmann applanation tonometer, and CMT measured on the same OCT device for all eyes (Cirrus 6000 HD-OCT; Carl Zeiss Meditec, Germany). Because early OCT can be confounded by intraocular gas, CMT was analyzed from month 1 onward. Operative timing comprised: total surgical time (from initiation of sub-Tenon anesthesia to completion of the final sub-Tenon antibiotic\u0026ndash;steroid injection), core vitrectomy time (cumulative cutter-on time during central vitrectomy), and ERM\u0026ndash;ILM peeling time (from initiation to completion of peeling). Intraoperative hemorrhage and other complications were recorded. Instrument utilization was prospectively noted as the number of light probes and vitrectomy cutters used (single vs\u0026thinsp;\u0026ge;\u0026thinsp;2). Presence of metamorphopsia at month 12 was assessed with an Amsler grid (present/absent). The primary outcomes were total surgical time, core vitrectomy time, and ERM\u0026ndash;ILM peeling time; secondary outcomes were BCVA, IOP, and CMT values up to month 12, 12-month metamorphopsia, and intraoperative instrument changes/complications. Demographics (age, sex), lens status (phakic/pseudophakic), gauge group, and all outcome data were extracted into a standardized database; only eyes with complete 12-month data were included (complete-case analysis, no imputation). Cases in which intraoperative complications that could prolong surgical time occurred, such as intraocular hemorrhage, retinal detachment, intraocular lens dislocation, or posterior capsule rupture, were excluded from the study.\u003c/p\u003e\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eStatistical analysis\u003c/h2\u003e\u003cp\u003eContinuous variables were summarized as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation and median (range), and categorical variables as counts and percentages. Normality was assessed using Kolmogorov\u0026ndash;Smirnov and Shapiro\u0026ndash;Wilk tests. Between-group comparisons employed the Mann\u0026ndash;Whitney U test for continuous/non-normally distributed data and χ\u0026sup2; or Fisher\u0026rsquo;s exact tests for categorical data, as appropriate. All tests were two-sided with a significance threshold of P\u0026thinsp;\u0026lt;\u0026thinsp;0.05. Analyses were performed with SPSS version 27.0 (IBM Corp., Armonk, NY, USA).\u003c/p\u003e\u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eA total of 107 eyes met inclusion criteria and were analyzed (27G, n\u0026thinsp;=\u0026thinsp;68; 25G, n\u0026thinsp;=\u0026thinsp;39). The mean age was 64.6\u0026thinsp;\u0026plusmn;\u0026thinsp;7.9 years (range, 50\u0026ndash;83) and 55.1% were male (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Baseline characteristics were balanced between groups with no differences in age, sex, or lens status (all \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05). Functional (BCVA) and anatomic (CMT) outcomes showed similar longitudinal trends between the 25G and 27G groups throughout follow-up. BCVA showed the expected immediate postoperative decline at day 1 followed by progressive improvement, with no between-group differences at any visit from baseline through month 12 (all \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05; Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e; Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Intraoperative instrument use was also comparable: the proportion requiring\u0026thinsp;\u0026ge;\u0026thinsp;2 light probes and the proportion requiring\u0026thinsp;\u0026ge;\u0026thinsp;2 vitrectomy cutters did not differ between 27G and 25G (light probe: \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.300; cutter: \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.651; Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eComparison of demographic characteristics, surgical parameters, and postoperative outcomes between 27-gauge and 25-gauge pars plana vitrectomy groups.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"8\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e27 Gauge (n\u0026thinsp;=\u0026thinsp;68)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003e25 Gauge (n\u0026thinsp;=\u0026thinsp;39)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003ep\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"1\" nameend=\"c8\" namest=\"c8\"\u003e\u0026nbsp;\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD / n-%\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eMedian\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD / n-%\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eMedian\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"1\" nameend=\"c8\" namest=\"c8\"\u003e\u0026nbsp;\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e63.6\u0026thinsp;\u0026plusmn;\u0026thinsp;8.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e66.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e66.2\u0026thinsp;\u0026plusmn;\u0026thinsp;7.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e66.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.207 (m)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c8\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eSex\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e26 / 38.2%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e22 / 56.4%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.069 (X\u0026sup2;)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c8\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e42 / 61.8%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e17 / 43.6%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c8\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eLens Status\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePhakic\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e52 / 76.5%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e34 / 87.2%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.179 (X\u0026sup2;)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c8\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePseudophakic\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e16 / 23.5%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e5 / 12.8%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c8\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eLight Probe Used\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e63 / 92.6%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e38 / 97.4%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.300 (X\u0026sup2;)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c8\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026ge;\u0026thinsp;2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5 / 7.4%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1 / 2.6%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c8\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eVitrectomy Probe Used\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e64 / 94.1%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e38 / 97.4%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.651 (X\u0026sup2;)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c8\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026ge;\u0026thinsp;2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4 / 5.9%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1 / 2.6%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c8\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eSurgical Times (min)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eERM-ILM Peel Time\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e8.1\u0026thinsp;\u0026plusmn;\u0026thinsp;2.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e8.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e9.4\u0026thinsp;\u0026plusmn;\u0026thinsp;2.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e10.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.073 (m)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c8\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCore Time\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e27.8\u0026thinsp;\u0026plusmn;\u0026thinsp;10.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e26.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e21.8\u0026thinsp;\u0026plusmn;\u0026thinsp;9.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e22.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.014 (m)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c8\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTotal Time\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e45.6\u0026thinsp;\u0026plusmn;\u0026thinsp;9.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e43.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e38.1\u0026thinsp;\u0026plusmn;\u0026thinsp;10.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e43.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.001 (m)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"1\" nameend=\"c8\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e\u003cp\u003e\u003cem\u003em: Mann\u0026ndash;Whitney U test, X\u0026sup2;: Chi-square or Fisher\u0026rsquo;s exact test\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e[ Insert Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e ]\u003c/p\u003e\u003cp\u003eFigure \u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. BCVA (logMAR) at baseline and follow-up visits in the 27G and 25G groups. Both groups showed an early postoperative decline followed by progressive improvement, with no significant differences at any time point.\u003c/p\u003e\u003cp\u003eIOP likewise did not differ between groups at any time point (all \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05; Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). CMT showed a significant postoperative decrease in both gauge groups. Due to the presence of SF₆ gas occupying more than half of the vitreous cavity on postoperative day 1, reliable OCT imaging could not be obtained at that time in most eyes. Furthermore, gas resorption was still ongoing during the first postoperative week, and thus OCT was not available for all cases at that point. However, by the first postoperative month, complete CMT data were available for the entire cohort, allowing for robust comparison. At this time point, both groups demonstrated a marked reduction in CMT, reflecting the early anatomic response to ERM\u0026ndash;ILM peeling. This reduction continued steadily until month 3, after which CMT values stabilized in both groups. No statistically significant differences in CMT were detected between the 27G and 25G groups at months 1, 3, 6, or 12, indicating similar anatomical recovery profiles across gauge types (all \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05; Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e; Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). At month 12, metamorphopsia was reported by 52.9% of 27G eyes and 41.0% of 25G eyes, a difference that was not statistically significant (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.235; Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003ePostoperative changes in best-corrected visual acuity, intraocular pressure, central macular thickness, and presence of metamorphopsia in the 27-gauge and 25-gauge groups.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"10\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e27 Gauge (n\u0026thinsp;=\u0026thinsp;68)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u003cp\u003e25 Gauge (n\u0026thinsp;=\u0026thinsp;39)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c10\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003ep\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eMedian\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u003cp\u003eMedian\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\" morerows=\"6\" rowspan=\"7\"\u003e\u003cp\u003eBCVA (LogMAR)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePreop\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.6\u0026thinsp;\u0026plusmn;\u0026thinsp;0.4\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.5\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.7\u0026thinsp;\u0026plusmn;\u0026thinsp;0.4\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.7\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c10\"\u003e\u003cp\u003e0.277 (m)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c2\" morerows=\"5\" rowspan=\"6\"\u003e\u003cp\u003ePostop\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eDay 1\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.7\u0026thinsp;\u0026plusmn;\u0026thinsp;0.3\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.1\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1.6\u0026thinsp;\u0026plusmn;\u0026thinsp;0.3\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u003cp\u003e1.6\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c10\"\u003e\u003cp\u003e0.054 (m)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eWeek 1\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.1\u0026thinsp;\u0026plusmn;\u0026thinsp;0.4\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.3\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1.1\u0026thinsp;\u0026plusmn;\u0026thinsp;0.4\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u003cp\u003e1.3\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c10\"\u003e\u003cp\u003e0.922 (m)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eMonth 1\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.3\u0026thinsp;\u0026plusmn;\u0026thinsp;0.2\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.2\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.2\u0026thinsp;\u0026plusmn;\u0026thinsp;0.2\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.2\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c10\"\u003e\u003cp\u003e0.697 (m)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eMonth 3\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.2\u0026thinsp;\u0026plusmn;\u0026thinsp;0.1\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.2\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.2\u0026thinsp;\u0026plusmn;\u0026thinsp;0.2\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.2\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c10\"\u003e\u003cp\u003e0.997 (m)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eMonth 6\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.2\u0026thinsp;\u0026plusmn;\u0026thinsp;0.1\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.2\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.2\u0026thinsp;\u0026plusmn;\u0026thinsp;0.2\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.2\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c10\"\u003e\u003cp\u003e0.840 (m)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eMonth 12\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.2\u0026thinsp;\u0026plusmn;\u0026thinsp;0.1\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.2\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.2\u0026thinsp;\u0026plusmn;\u0026thinsp;0.1\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.2\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c10\"\u003e\u003cp\u003e0.606 (m)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\" morerows=\"6\" rowspan=\"7\"\u003e\u003cp\u003eIOP (mmHg)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePreop\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003e13.7\u0026thinsp;\u0026plusmn;\u0026thinsp;2.7\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003e14.0\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003e13.5\u0026thinsp;\u0026plusmn;\u0026thinsp;2.8\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u003cp\u003e14.0\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c10\"\u003e\u003cp\u003e0.862 (m)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c2\" morerows=\"5\" rowspan=\"6\"\u003e\u003cp\u003ePostop\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eDay 1\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003e15.2\u0026thinsp;\u0026plusmn;\u0026thinsp;5.0\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003e15.0\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003e13.6\u0026thinsp;\u0026plusmn;\u0026thinsp;5.0\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u003cp\u003e14.0\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c10\"\u003e\u003cp\u003e0.080 (m)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eWeek 1\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003e14.4\u0026thinsp;\u0026plusmn;\u0026thinsp;2.4\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003e15.0\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003e15.2\u0026thinsp;\u0026plusmn;\u0026thinsp;2.8\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u003cp\u003e15.0\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c10\"\u003e\u003cp\u003e0.320 (m)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eMonth 1\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003e14.8\u0026thinsp;\u0026plusmn;\u0026thinsp;2.2\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003e15.0\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003e14.4\u0026thinsp;\u0026plusmn;\u0026thinsp;2.2\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u003cp\u003e14.0\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c10\"\u003e\u003cp\u003e0.328 (m)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eMonth 3\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003e15.0\u0026thinsp;\u0026plusmn;\u0026thinsp;2.3\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003e15.0\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003e14.5\u0026thinsp;\u0026plusmn;\u0026thinsp;2.4\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u003cp\u003e14.0\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c10\"\u003e\u003cp\u003e0.279 (m)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eMonth 6\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003e15.2\u0026thinsp;\u0026plusmn;\u0026thinsp;2.5\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003e15.0\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003e14.4\u0026thinsp;\u0026plusmn;\u0026thinsp;2.5\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u003cp\u003e14.0\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c10\"\u003e\u003cp\u003e0.070 (m)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eMonth 12\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003e15.1\u0026thinsp;\u0026plusmn;\u0026thinsp;2.4\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003e15.0\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003e14.5\u0026thinsp;\u0026plusmn;\u0026thinsp;2.3\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u003cp\u003e14.0\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c10\"\u003e\u003cp\u003e0.208 (m)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e\u003cp\u003eCMT (\u0026micro;m)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePreop\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003e429.1\u0026thinsp;\u0026plusmn;\u0026thinsp;73.1\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003e412.0\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003e420.9\u0026thinsp;\u0026plusmn;\u0026thinsp;67.2\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u003cp\u003e401.0\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c10\"\u003e\u003cp\u003e0.729 (m)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c2\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003ePostop\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eMonth 1\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003e362.8\u0026thinsp;\u0026plusmn;\u0026thinsp;50.2\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003e360.0\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003e370.6\u0026thinsp;\u0026plusmn;\u0026thinsp;47.0\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u003cp\u003e363.0\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c10\"\u003e\u003cp\u003e0.380 (m)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eMonth 3\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003e371.6\u0026thinsp;\u0026plusmn;\u0026thinsp;42.2\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003e364.0\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003e354.3\u0026thinsp;\u0026plusmn;\u0026thinsp;46.3\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u003cp\u003e356.0\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c10\"\u003e\u003cp\u003e0.053 (m)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eMonth 6\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003e354.4\u0026thinsp;\u0026plusmn;\u0026thinsp;37.2\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003e355.0\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003e355.1\u0026thinsp;\u0026plusmn;\u0026thinsp;40.2\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u003cp\u003e360.0\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c10\"\u003e\u003cp\u003e0.838 (m)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eMonth 12\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003e351.9\u0026thinsp;\u0026plusmn;\u0026thinsp;31.6\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003e352.0\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003e358.1\u0026thinsp;\u0026plusmn;\u0026thinsp;29.5\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u003cp\u003e355.0\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c10\"\u003e\u003cp\u003e0.416 (m)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMetamorphopsia\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePostop\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eMonth 12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e36 / 52.9%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e16 / 41.0%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e0.235 (X\u0026sup2;)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"10\" nameend=\"c10\" namest=\"c1\"\u003e\u003cp\u003e\u003cem\u003eBCVA: best-corrected visual acuity; CMT: central macular thickness; IOP: intraocular pressure; LogMAR: logarithm of the minimum angle of resolution; SD: standard deviation; Med: median; \u0026micro;m: micrometer; m: Mann\u0026ndash;Whitney U test, X\u0026sup2;: Chi-square or Fisher\u0026rsquo;s exact test\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e[ Insert Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e ]\u003c/p\u003e\u003cp\u003eFigure \u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e. Change in central macular thickness (CMT) over time in the 27G and 25G groups. Both groups demonstrated a marked reduction postoperatively, with sustained improvements throughout follow-up and no intergroup differences.\u003c/p\u003e\u003cp\u003eRegarding surgical performance metrics, ERM\u0026ndash;ILM peel duration was longer in the 25G group than in the 27G group (9.4\u0026thinsp;\u0026plusmn;\u0026thinsp;2.5 vs 8.1\u0026thinsp;\u0026plusmn;\u0026thinsp;2.2 minutes; \u003cem\u003eP\u0026thinsp;=\u003c/em\u003e\u0026thinsp;0.073), whereas both core vitrectomy time and total surgical time were longer with 27G (core: 27.8\u0026thinsp;\u0026plusmn;\u0026thinsp;10.8 vs 21.8\u0026thinsp;\u0026plusmn;\u0026thinsp;9.1 minutes, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.014; total: 45.6\u0026thinsp;\u0026plusmn;\u0026thinsp;9.4 vs 38.1\u0026thinsp;\u0026plusmn;\u0026thinsp;10.4 minutes, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.001; Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). The broader dispersion and right-shift of core times in the 27G cohort are visualized in Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e, which also depicts the distribution of total surgery times.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e[ Insert Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e ]\u003c/p\u003e\u003cp\u003eFigure \u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e. Dot plots illustrating operative durations. (Left) Distribution of core vitrectomy times in the 25G and 27G groups. (Right) Distribution of total surgery times. Both operative parameters were significantly longer in the 27G group compared with the 25G group (core time, P\u0026thinsp;=\u0026thinsp;0.014; total time, P\u0026thinsp;=\u0026thinsp;0.001).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eTransconjunctival microincision vitrectomy has progressively shifted from 20G to 27G with the aim of reducing complications and enhancing early postoperative comfort. In idiopathic ERM surgery, both 25G and 27G approaches have been widely adopted and shown to yield similar visual, functional, and anatomical outcomes [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan additionalcitationids=\"CR16\" citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. However, reports diverge on intraoperative ease and duration, with some series describing longer vitrectomy segments and total operating times with 27G, while others note minimal or step-specific differences limited to core removal or peeling [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eIn our study, both BCVA and CMT improved postoperatively in a statistically and clinically similar manner in the 27G and 25G groups, suggesting that functional and anatomical recovery was not influenced by gauge size. These results are in alignment with the current evidence from most comparative studies on idiopathic ERM surgery, which consistently demonstrate that postoperative outcomes remain effective and reproducible across different vitrectomy gauge systems [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. Following an effective vitrectomy and meticulous ERM\u0026ndash;ILM peeling, visual acuity showed a progressive postoperative improvement that paralleled the anatomical recovery, as evidenced by a continuous reduction in central macular thickness [\u003cspan additionalcitationids=\"CR21 CR22\" citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. The resolution of tangential traction enables the restoration of foveal contour, reduction of inner retinal thickening and microfolds, and gradual reorganization of the outer retinal layers. Among these structural parameters, the integrity of the ellipsoid zone and the external limiting membrane has been shown to correlate closely with postoperative visual improvement [\u003cspan additionalcitationids=\"CR22\" citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eIn our series, the transient decline in visual acuity observed on postoperative day 1, along with the inability to obtain reliable CMT measurements during the early postoperative period, was primarily attributable to the presence of intraocular gas, which obstructed the visualization of the posterior segment and interfered with OCT signal acquisition [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. As the gas gradually resorbed, BCVA improved markedly and CMT became measurable, with the decrease in thickness closely accompanying the functional recovery [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. Notably, anatomical and visual improvement was already apparent by the first postoperative month in both gauge groups and continued to progress in logMAR terms. However, from month 3 through month 12, both BCVA and CMT values remained stable, without any statistically significant difference between the 27G and 25G groups [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. Although small numerical differences in CMT were observed between the two groups at months 3, 6, and 12, none of these reached statistical significance. This eventual anatomical convergence is consistent with previous ERM literature, which shows that macular remodeling typically stabilizes by 3 to 6 months postoperatively, even though some patients may continue to experience gradual functional adaptation thereafter [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. Metamorphopsia persisted in approximately half of eyes at month 12, with no between-group difference. This rate is consistent with prior literature underscoring that symptomatic distortion can outlast anatomic normalization, likely reflecting inner retinal remodeling and protracted cortical adaptation rather than incomplete membrane removal per se [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. The lack of a gauge effect here reinforces that final subjective vision is more tightly tied to preoperative microstructure of the retina and completeness of peel than to cannula diameter.\u003c/p\u003e\u003cp\u003eIn small-gauge transconjunctival PPV, early postoperative IOP can vary with trocar entry architecture, sclerotomy diameter, oblique/tunneled wound construction, and the use or omission of sutures [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. In our study, day-1 IOP values showed a wide distribution. IOP was similar between groups, and no clinically significant hypotony or ocular hypertension was observed on postoperative day 1. In both groups, all three ports were left sutureless after gentle external massage and controlled venting of residual gas, and physiologic tone was confirmed intraoperatively by digital palpation. This standardized closure was associated with the absence of early pressure extremes; the broad day-1 spread likely reflects variable gas fill, transient wound apposition dynamics, and physiologic fluctuation (see Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Across follow-up, IOP remained stable, and no visit showed a statistically significant difference between the 25G and 27G groups; these findings are consistent with comparative series reporting similar pressure profiles across gauges [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Contemporary small-incision techniques employing angled/tunneled sclerotomies and smaller port diameters may further mitigate clinically relevant hypotony and support early pressure stability, which is consistent with our results [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eOperative timing in our analysis showed a step-specific divergence between gauges. Core vitrectomy and total surgical duration were longer with 27G, whereas ERM\u0026ndash;ILM peeling tended to take longer with 25G. The most direct explanation lies in vitrectomy fluidics and instrument mechanics. The wider lumen of 25G permits greater vitreous throughput per unit time, which accelerates core removal even when cut rates are matched. The stiffer 25G shaft resists bending, so the cutter tracks more predictably during broad sweeps of the mid-vitreous and requires fewer micro-corrections. By contrast, the narrower 27G lumen limits volumetric flow and the more flexible shaft is susceptible to small deflections, which slows evacuation and introduces brief pauses for repositioning despite modern platforms [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. In our series, bending events and intraoperative exchanges of light probes or cutters were numerically more frequent with 27G, but the difference was not statistically significant, which suggests that micro-interruptions contribute to the observed timing yet are not the sole driver. The concentration of delay in the core vitrectomy segment propagated to a longer total case time in the 27G group, a pattern that mirrors reports describing extended vitrectomy or overall times with 27G in ERM surgery while long-term outcomes remain similar between gauges [\u003cspan additionalcitationids=\"CR11\" citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Other studies have shown minimal differences or context-dependent results, likely reflecting platform and case-mix variation, yet the prevailing signal favors a small time penalty for 27G core work under routine conditions [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Bench-top and intraoperative observations indicate that 27G instruments have lower bending stiffness and are more prone to deflection or tip deformation under load, particularly with oblique trocar trajectories or during anterior maneuvers [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Our timing data are consistent with this behavior and suggest that even when exchanges are infrequent, the small pauses and reorientations imposed by flexibility accumulate and lengthen overall operating time.\u003c/p\u003e\u003cp\u003eBy contrast, peeling took longer with 25G in our series. A plausible explanation is that greater shaft rigidity, while transmitting force efficiently, affords less compliance at the instrument tip during close-quarters maneuvers on the macula. The slightly more flexible 27G forceps and sweepers may permit smoother micro-adjustments, fewer regrasping attempts, and steadier traction vectors once a flap is initiated, which shortens the sequence of peel\u0026ndash;release\u0026ndash;reposition cycles [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Consistent with this interpretation, a randomized comparison reported no disadvantage to 27G for ERM\u0026ndash;ILM peeling time, and other series have described equal or faster peeling with 27G despite similar long-term outcomes between gauges [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Taken together, these observations suggest that any gauge effect on peeling is small and often overshadowed by technique and case complexity, whereas the more pronounced timing difference resides in the core segment driven by gauge-dependent fluidics.\u003c/p\u003e\u003cp\u003eThis study benefits from a uniform indication, a single surgical platform and step-specific timing performed by one surgeon, which reduced variability. The retrospective design and nonrandom gauge allocation remain limitations. The sample size was modest for rare intraoperative events, and metamorphopsia was assessed with an Amsler grid. Early OCT was limited in gas-filled eyes, which prevented ultra-acute CMT assessment. These factors may have attenuated sensitivity to small differences. Future prospective studies on standardized platforms will help define how instrumentation and technique modulate the observed timing effects.\u003c/p\u003e\u003cp\u003eIn summary, our data indicate that 25G and 27G deliver similar visual and anatomical outcomes, while operative efficiency differs in a gauge-dependent and step-specific manner. The time penalty with 27G is concentrated in the core vitrectomy and carries through to the total case duration, whereas any difference during peeling is small and variable. These patterns are consistent with differences in lumen size, flow and shaft behavior, and they highlight the value of tailoring technique to the chosen gauge. Surgeons can optimize trocar trajectory, infusion settings and instrument choice to reduce micro-delays and streamline the core segment. Gauge choice can therefore be aligned with priorities such as throughput, wound micro-trauma and postoperative comfort rather than expectations of different long-term endpoints.\u003c/p\u003e\u003cp\u003e As the study was conducted retrospectively using anonymized data obtained from routine clinical examinations and surgical procedures, the requirement for informed consent was formally waived by the ethics committee. No additional interventions were performed, and no identifiable patient information was used.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003cp\u003e This study was approved by the Clinical Research Ethics Committee of Tekirdağ Namık Kemal University (Approval No: 2022.194.10.18). The study adhered to the tenets of the Declaration of Helsinki. Written informed consent was obtained from all patients prior to surgery.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003cp\u003eNot applicable.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e\u003cp\u003eThe authors received no external funding for this research.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eEkrem Celik: Conceptualization, surgical procedures, data curation, literature review, statistical analysis, and critical revision of the manuscript; Evrim Polat: Literature review, statistical analysis, figure preparation, and manuscript drafting. Both authors read and approved the final manuscript.\u003c/p\u003e\u003ch2\u003eAcknowledgements\u003c/h2\u003e\u003cp\u003eNot applicable.\u003c/p\u003e\u003ch2\u003eData availability\u003c/h2\u003e\u003cp\u003eThe datasets generated and/or analyzed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eFung AT, Galvin J, Tran T. Epiretinal membrane: a review. Clin Exp Ophthalmol. 2021;49(6):712\u0026ndash;29.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eXiao W, Chen X, Yan W, et al. Prevalence and risk factors of epiretinal membranes: a systematic review and meta-analysis. Clin Exp Ophthalmol. 2020;48(8):1048\u0026ndash;61.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eEnglmaier V, et al. Short-term outcomes of idiopathic epiretinal membranes following pars plana vitrectomy with ERM\u0026ndash;ILM peeling. BMC Ophthalmol. 2023;23:496.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKanai M, et al. Long-term risk factors for poor visual outcomes in pars plana vitrectomy with ERM peeling. Sci Rep. 2024;14:80020.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eFujii GY, De Juan E Jr, Humayun MS, et al. A new 25-gauge instrument system for transconjunctival sutureless microincision vitrectomy surgery. Ophthalmology. 2002;109(10):1807\u0026ndash;12.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eEckardt C. Transconjunctival sutureless 23-gauge vitrectomy. Retina. 2005;25(2):208\u0026ndash;11.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eOshima Y, Wakabayashi T, Sato T, Ohji M, Tano Y. A 27-gauge instrument system for transconjunctival sutureless microincision vitrectomy surgery. Ophthalmology. 2010;117(1):93\u0026ndash;e1022.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eShimada H, Nakashizuka H, Hattori T, Mori R, Mizutani Y. 27-gauge vitrectomy versus 25-gauge vitrectomy for idiopathic epiretinal membrane. Retina. 2018;38(2):299\u0026ndash;307.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eNagpal M, Mehrotra N, Juneja R, Jain P. 27-Gauge vitrectomy system for epiretinal membrane surgery: comparison of surgical outcomes and complications with 25-Gauge system. Retina. 2018;38(Suppl 1):S45\u0026ndash;50.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMitsui K, Kogo J, Takeda H, et al. Comparison of 25-gauge and 27-gauge vitrectomy for idiopathic epiretinal membrane. J Ophthalmol. 2017;2017:5672742.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eNaruse S, Shimada H, Mori R. 27-gauge and 25-gauge vitrectomy day surgery for idiopathic epiretinal membrane. BMC Ophthalmol. 2017;17:188.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLubiński W, Podborączyńska-Jodko K, Penkala K, Post M, Mrukwa-Kominek E. 25G versus 27G vitrectomy for idiopathic epiretinal membrane removal: a prospective randomized trial. Ophthalmol J. 2022;7(3):211\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBrown GC, et al. Vitrectomy instrumentation comparison: 25G vs 27G for macular disease. Retina Today. 2020;15(2):35\u0026ndash;40.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eOkamoto F, Okamoto Y, Fukuda S, Hiraoka T, Oshika T. Vision-related quality of life and visual function after pars plana vitrectomy for epiretinal membrane. PLoS ONE. 2015;10(6):e0128011.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eOhta T, Inoue M, Shinoda K, et al. Comparative study of 25- and 27-gauge vitrectomy for idiopathic epiretinal membrane. Retina. 2014;35(11):2317\u0026ndash;21.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLiu Y, Zeng Y, Ma J, et al. Comparison of anatomical and functional outcomes after 25-G and 27-G vitrectomy for idiopathic epiretinal membrane. BMC Ophthalmol. 2022;22(1):53.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHikichi T, Fujio N, Akiba J. Comparison of postoperative outcomes between 25-gauge and 27-gauge vitrectomy for idiopathic epiretinal membrane. J Clin Exp Ophthalmol. 2017;8(1):1000643.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKarimi S, Entezari M, Feizi M, et al. Comparing outcomes of 27-gauge and 25-gauge vitrectomy in the treatment of idiopathic epiretinal membrane. Int J Retina Vitreous. 2020;6:11.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eNarayanan R, Singh SR, Taylor S, Berrocal MH. Outcomes of 25-gauge versus 27-gauge pars plana vitrectomy for macular surgery: a systematic review and meta-analysis. Indian J Ophthalmol. 2023;71(6):2219\u0026ndash;27.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eOzturker C, Karabas L, Cakir B, et al. Relationship between central macular thickness and visual acuity improvement after epiretinal membrane surgery. Int J Ophthalmol. 2018;11(6):1022\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eYang HS, Lee JH, Kim JW, et al. Correlation between spectral-domain optical coherence tomography findings and visual acuity after surgery for idiopathic epiretinal membrane. Retina. 2013;33(9):1791\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRipandelli G, Coppe AM, Parisi V, et al. Functional and anatomical changes following epiretinal membrane surgery: a follow-up study. Graefes Arch Clin Exp Ophthalmol. 2015;253(1):47\u0026ndash;56.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRomano MR, Comune C, Ferrara M, et al. Evaluation of anatomical and functional outcomes using spectral-domain optical coherence tomography in idiopathic epiretinal membranes. Graefes Arch Clin Exp Ophthalmol. 2011;249(10):1465\u0026ndash;70.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSandali O, El Sanharawi M, Paraf F, et al. Epiretinal membrane surgery: safety and functional outcomes in young and older patients. Graefes Arch Clin Exp Ophthalmol. 2010;248(3):305\u0026ndash;11.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKhan MA, Shahlaee A, Toussaint B, Kuriyan AE, Valikodath NG, Hsu J, et al. Outcomes of 27-gauge microincision vitrectomy surgery for posterior segment disease. Br J Ophthalmol. 2016;100(7):939\u0026ndash;43.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-ophthalmology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"boph","sideBox":"Learn more about [BMC Ophthalmology](http://bmcophthalmol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/boph","title":"BMC Ophthalmology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Epiretinal membrane, Microincision vitrectomy, 25-gauge, 27-gauge, surgical time","lastPublishedDoi":"10.21203/rs.3.rs-7802678/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7802678/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eTo compare operative efficiency, efficacy, and safety of 25-gauge (25G) versus 27-gauge (27G) microincision vitrectomy systems for idiopathic epiretinal membrane (ERM) surgery in a homogeneous cohort.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eRetrospective, single-center series of consecutive eyes operated between March 2021 and January 2023, with \u0026ge;\u0026thinsp;12-month follow-up. All surgeries were performed by the same vitreoretinal surgeon using a standardized platform. Outcomes included best-corrected visual acuity (BCVA, logMAR), intraocular pressure (IOP), central macular thickness (CMT), ERM\u0026ndash;ILM peel time, core vitrectomy time, total surgical time, and 12-month metamorphopsia (Amsler grid). Intraoperative instrument use (light probe and vitrectomy cutter: single vs\u0026thinsp;\u0026ge;\u0026thinsp;2) was recorded.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eA total of 107 eyes were analyzed (27G, n\u0026thinsp;=\u0026thinsp;68; 25G, n\u0026thinsp;=\u0026thinsp;39). Baseline age, sex, and lens status did not differ between groups. ERM\u0026ndash;ILM peel duration was longer with 25G (9.4\u0026thinsp;\u0026plusmn;\u0026thinsp;2.5 vs 8.1\u0026thinsp;\u0026plusmn;\u0026thinsp;2.2 min; \u003cem\u003eP\u0026thinsp;=\u003c/em\u003e\u0026thinsp;0.073). Core vitrectomy and total surgical times were longer with 27G (core: 27.8\u0026thinsp;\u0026plusmn;\u0026thinsp;10.8 vs 21.8\u0026thinsp;\u0026plusmn;\u0026thinsp;9.1 min, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.014; total: 45.6\u0026thinsp;\u0026plusmn;\u0026thinsp;9.4 vs 38.1\u0026thinsp;\u0026plusmn;\u0026thinsp;10.4 min, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.001). BCVA improved significantly in both groups with no between-group differences at any visit through month 12. During follow-up, IOP and CMT values were also similar between groups (all P\u0026thinsp;\u0026gt;\u0026thinsp;0.05). Twelve-month metamorphopsia was statistically similar between the 27G and 25G groups (52.9% vs 41.0%; P\u0026thinsp;=\u0026thinsp;0.235). Although 27G instruments are more flexible and occasionally deformed intraoperatively, the need to replace light probes or vitrectomy cutters due to bending was not significantly different from 25G (light 6/68 vs 1/39; cutter 4/68 vs 1/39; both P\u0026thinsp;\u0026gt;\u0026thinsp;0.05).\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003eIn idiopathic ERM surgery, 25- and 27-gauge systems achieve similar 12-month visual and anatomical outcomes. Operative profiles differ: 27G is associated with longer core and total times, whereas 25G shows longer peeling time. These differences likely reflect instrument rigidity/flexibility rather than efficacy. Gauge selection may be individualized according to surgical priorities (time efficiency versus minimal incision).\u003c/p\u003e","manuscriptTitle":"25- Versus 27-Gauge Vitrectomy for Idiopathic Epiretinal Membrane: Operative Time and Outcomes in a Homogeneous Cohort","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-10-29 04:01:05","doi":"10.21203/rs.3.rs-7802678/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2026-04-22T15:50:08+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-06T09:42:53+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"173621940093258039035620129493609211480","date":"2026-04-01T13:06:52+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"224200862465198871518314907106069551796","date":"2026-03-08T19:31:44+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-10-14T04:56:47+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-10-09T07:09:53+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-10-08T03:55:42+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-10-08T03:54:55+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Ophthalmology","date":"2025-10-07T21:22:24+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-ophthalmology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"boph","sideBox":"Learn more about [BMC Ophthalmology](http://bmcophthalmol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/boph","title":"BMC Ophthalmology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"d5e127ba-52ba-40d2-b716-902886587b4c","owner":[],"postedDate":"October 29th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-10-29T04:01:05+00:00","versionOfRecord":[],"versionCreatedAt":"2025-10-29 04:01:05","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7802678","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7802678","identity":"rs-7802678","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}