Clinical Performance of 18-mm Short Vitrectomy Probe for Retinal Surgery in Pediatric Patients

Clinical Performance of 18-mm Short Vitrectomy Probe for Retinal Surgery in Pediatric Patients | 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 Clinical Performance of 18-mm Short Vitrectomy Probe for Retinal Surgery in Pediatric Patients Margaret Ming-Chih Ho, Hung-Da Chou, Eugene Yu-Chuan Kang, Yi-Hsing Chen, and 6 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7173130/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background To report the surgical outcomes, safety, effectiveness, and reliability of 18-millimeter short vitrectomy probes in pediatric vitreoretinal surgery. Methods This was a prospective, interventional study. We recruited participants under 18 years of age scheduled for vitrectomy due to various etiologies at Chang Gung Memorial Hospital, Linkou branch, from 2022 to 2025. Comprehensive pre-and postoperative ocular examinations were performed. The primary outcome measures were the safety of the instrument, including the durability and incidence of iatrogenic complications such as lens touch and retinal injury. The secondary outcome measured the overall comfort and reliability of the instrument during surgery, as assessed by a retinal surgeon using a questionnaire. Results Sixteen children (18 eyes) were enrolled with a mean age of 4.9 ± 4.3 years old. No incidences of instrument bending, iatrogenic retinal injury, or other complications occurred during surgery. The instrument received a top rating of 4.6 out of 5 for the overall comfort rated by the surgeon. Average ease of instrument rotation, ease of instrument extension to the peripheral retina, and ease of eyeball rotation were rated as 4.5 ± 0.7, 4.3 ± 0.9, and 4.6 ± 0.6 out of 5 points, respectively. Sixteen eyes (88.9%) achieved their surgical goals. Conclusions The 18-millimeter short vitrectomy probe is a safe and effective surgical instrument for pediatric vitrectomy, which improves the overall comfort of retinal surgeons and ensures success in pediatric vitreoretinal surgeries. Ophthalmology Surgery 18-mm short vitrectomy probe pediatric retinal surgery persistent fetal vasculature retinopathy of prematurity retinal detachment vitrectomy Figures Figure 1 Figure 2 Introduction With advancements in small-gauge vitrectomy, an increasing number of pediatric vitreoretinal diseases can be effectively treated with intraocular surgery. However, pediatric vitreoretinal surgery presents unique challenges owing to anatomic and physiologic differences from adult eyes. 1 , 2 The pediatric eye has a smaller axial length and a thicker lens, making intraocular maneuvers more challenging and increasing the risk of intraoperative complications compared to adult vitrectomy. Additionally, the posterior vitreous firmly adheres to the retina, increasing the risk of iatrogenic retinal breaks when inducing posterior vitreous detachment. The greater elasticity of the pediatric sclera further complicates surgical precision by allowing excessive instrument mobility. Traditional 20- and 23-gauge vitrectomy probes are not optimized for pediatric eyes, posing maneuverability challenges, increasing surgical time, and increasing the risk of complications such as retinal damage, iatrogenic breaks, or detachment. 3 While smaller-gauge vitrectors, such as 27-gauge vitrectors, improve intraocular stability during surgery and reduce the need for wound suturing, finer gauges are more flexible, making instrument control more difficult due to increased susceptibility to bending. 4 , 5 Furthermore, the conventional 34-mm vitrector is designed for adult eyes and is often impractical in pediatric cases because of its excessive length. Surgeons must alter their grip and hand positioning, which can be obstructed by a child’s nose, further complicating intraoperative control. Additionally, an excessive probe length increases the risk of inadvertent macular or choroidal injury, even with minor hand movements. Alternatively, an 18-mm ( Fig. 1 ) short vitrectomy kit was specially designed for pediatric retinal surgeries. With a short length of 18 mm, this vitrectomy probe may be more effective and safer for pediatric surgeries. This study aimed to investigate the safety, effectiveness, and reliability of using an 18-millimeter short vitrectomy probe for pediatric vitreoretinal surgery. Methods This study adhered to the Declaration of Helsinki and was approved by the Institutional Review Board of Chang Gung Memorial Hospital (IRB Registration Number: 202101643A0). The clinical protocol was approved by the Data and Safety Monitoring Plan Committee of the Chang Gung Memorial Hospital (DSMP number: 210570008). Written informed consent was obtained from parents and legal guardians. This study was registered at ClinicalTrials. gov (NCT06520410). Eligible Criteria In this prospective study, we recruited patients under 18 years of age who underwent vitrectomy due to variable etiologies, including retinopathy of prematurity, familial exudative vitreoretinopathy, persistent fetal vasculature, congenital cataract, lens dislocation, open-globe injury, vitreous hemorrhage, or other vitreoretinal diseases in children, at Chang Gung Memorial Hospital, Linkou branch, from 1st March, 2022 and 28th February, 2024. Clinical characteristics including age, sex, clinical diagnosis, and surgical indication were recorded. Comprehensive preoperative ocular examinations included best-corrected visual acuity (BCVA), intraocular pressure (IOP), slit-lamp biomicroscopy, optical coherence tomography (OCT), fluorescein angiography (FA) and indocyanine green angiography (ICG), color fundus and external eye photography, ocular ultrasonography, and ocular biometry will be obtained before operation. Patients who were unable to cooperate during the ophthalmic examinations or those with implanted defibrillators or pacemakers were excluded from the study. Vitrectomy All vitrectomies were performed by a single retinal specialist (W.C.W.) using 18-mm short vitrectomy kits (Alcon, Switzerland). The intraoperative use of indocyanine green, intraocular tamponade (air, Viscoat, octafluoropropane (C3F8), and sulfur hexafluoride (SF6)), and all other surgical procedures were performed at the discretion of the primary surgeon. The integrity of the short vitrectomy instruments and iatrogenic injuries, including lens touch and retinal damage, will also be documented. The surgeons completed a questionnaire regarding the overall reliability and comfort of using the 18 mm short vitrectomy probe immediately after the operation. Outcome Measurement The primary outcome measures were the safety of the instrument, including the durability and incidence of iatrogenic complications such as lens touch and retinal injury. The secondary outcome measures included the overall comfort and reliability of the instrument during surgery, as assessed by the retinal surgeon. The safety of the instrument includes the durability and incidence of iatrogenic complications, such as lens touch and retinal injury. Ocular examinations, including BCVA, IOP, OCT, FA, ICG, fundus and external eye photography, ocular ultrasonography, and ocular biometry, were performed at 1, 3, and 6 months postoperatively. Additional ophthalmic procedures were documented. Statistical analysis Continuous variables are presented as means and standard deviations, and were compared using a t -test. The Chi-square test was used to examine associations between categorical variables. Commercial software (IBM SPSS 24, Armonk, NY: IBM Corp.) was used for all data analyses. A p-value less than 0.05 was considered statistically significant. Results Table 1 presents the demographic and surgical details of the study cohort. Sixteen children (18 eyes; 9 male and 7 female patients) undergoing vitrectomy were enrolled. The mean age of our study cohort was 4.9 ± 4.3 years old. Surgical indications included persistent fetal vasculature (n = 5, 28%), retinopathy of prematurity (n = 4, 22%), rhegmatogenous retinal detachment (n = 4, 22%), optic pit maculopathy (n = 2, 11%), dense capsular opacity (n = 2, 11%), and congenital hypertrophy of the retinal pigment epithelium (CHRPE, n = 1, 6%). Two patients were excluded during the clinical trials. One patient was excluded because of death from pulmonary hypertension, kidney failure, or septic shock. The cause of death was not associated with an ocular pathology or retinal surgery. Another patient was excluded because the family decided to cancel the surgery and withdraw from the study. Surgical details of each patient are presented in Supplemental 1. Vitrectomy was performed in all patients; five patients underwent combined lensectomy and two patients underwent combined tractional membrane removal. The mean surgical time was 2.6 ± 1.4 h. No incidences of instrument bending, iatrogenic retinal injury, or other complications occurred during any of the procedures. No immediate intraoperative or postoperative complications such as endophthalmitis, postoperative hypotony, choroidal detachment, or ocular hypertension occurred during the postoperative 6-month clinic follow-up. Sixteen eyes (88.9%) achieved their surgical goals. One patient diagnosed with total retinal detachment had a dense vitreous hemorrhage with retinal detachment after surgery. Another patient diagnosed with optic pit maculopathy still had shallow retinal detachment after surgery. All patients in this study were followed up for at least six months after surgery. The mean follow-up duration was 6.8 ± 1.8 months. Table 1 Demographics in Our Study Cohort Patients, n (eyes) 16 (18) Age, yrs, mean (SD) 4.9 (4.3) Sex, male, n, (%) 10 (63) Laterality, patient, (%) Right 7 (44) Left 7 (44) Bilateral 2 (13) Diagnosis, eyes, (%) Persistent fetal vasculature 5 (28) Retinopathy of prematurity 4 (22) Rhegmatogenous retinal detachment 4 (22) Optic pit maculopathy 2 (11) Dense capsular opacity 2 (11) CHRPE 1 (6) Surgical Details Combine lensectomy 5 (28) Combine tractional membrane removal 2 (11) Gas tamponade † 5 (28) Silicone oil tamponade 2 (11) Surgical duration, hrs, mean (SD) 2.6 (1.4) Follow-up duration, mons, mean (SD) 6.8 (1.8) CHRPE: Congenital hypertrophy of the retinal pigment epithelium † Two with room air tamponade, one with SF6 tamponade, one with C3F8 tamponade The results of the questionnaire regarding the overall reliability and comfort of using the 18 mm short vitrectomy probe are shown in Fig. 2 . The instrument received a top rating of 4.8 ± 0.3 out of 5 for the overall comfort rated by the surgeon. The reliability and smoothness of the surgery were rated as 5 and 4.9 ± 0.2 out of 5, respectively. Average ease of instrument rotation, ease of instrument extension to the peripheral retina, and ease of eyeball rotation were rated as 4.7 ± 0.7, 3.8 ± 0.9, and 4.6 ± 0.6 out of 5 points, respectively. Discussion In this prospective study involving 16 children (18 eyes) who underwent vitrectomy using an 18-mm 25-gauge short vitrectomy probe, excellent ratings were observed for surgeon comfort and instrument reliability. No major post-operative complications were observed. To the best of our knowledge, this is the first study to evaluate the clinical performance and safety of a 25-gauge short probe vitrector during pediatric surgery. Additionally, this is the first study to assess both the overall comfort of a retinal surgeon and the reliability of the surgical instrument using a structured questionnaire. The 18-mm, 25-gauge short vitrectomy probe, specifically designed for pediatric retinal surgery, demonstrated several intraoperative advantages. First, its design enhances surgical safety. Because it is shorter than a traditional vitrector, it reduces the risk of iatrogenic retinal breaks and unnecessary hemorrhage. This is particularly crucial in pediatric retinal surgery, because iatrogenic breaks can lead to severe proliferative vitreoretinopathy, potentially resulting in devastating visual outcomes. 6 In the present study, no iatrogenic retinal breaks or other major complications were observed. Second, compared with the 27-gauge vitrector, which is commonly used in pediatric surgery, 7 – 9 this modified 25-gauge vitrector offers greater stiffness, reducing the likelihood of instrument bending during surgery. 10 Instrument bending increases the risk of unintended lens damage, which can lead to cataract formation after vitrectomy. Thus, the improved rigidity of the 25-gauge probe may contribute to better surgical precision and outcomes. Several challenges were encountered when using the short-probe vitrector in this study. Owing to its shorter length than that of traditional vitrectors, accessing the peripheral retina is more difficult, as reflected in the surgeons’ questionnaire responses. This limitation became more pronounced when performing surgery on older pediatric patients with longer axial lengths, such as patients 13 and 16 (Supplemental 1.) , both of whom were 13 years old. Pediatric surgeons must carefully consider these factors when selecting surgical instruments. Another drawback is instrument rotation. A shorter probe length resulted in a relatively shorter moment arm, making instrument rotation more challenging. Consequently, a greater effort is required to rotate the eyes during surgery. Additionally, the shorter probe amplified the vibrations transmitted to the surgeon’s hand, thereby increasing tactile feedback. Increased vibration perception may affect the surgeon’s comfort and precision, potentially influencing surgical outcomes. Nevertheless, in this study, we still found a high score (4.6 out of 5) for the overall comfort of the instrument, rated by the surgeon. Finally, a 25-gauge sclerotomy wound may still require suturing to prevent wound leakage and ensure a stable IOP postoperatively. Given that the sclera in children is softer and more elastic than that in adults, achieving a watertight sclerotomy is generally recommended to minimize the risk of postoperative hypotony. 1 , 11 , 12 However, in vitrectomy using a smaller-gauge probe, such as a 27-gauge probe, suturing of the wound might not be needed. 8 , 13 In our study, all surgical wounds were closed using 7 − 0 vicryl sutures. Because most cases involve gas or silicone oil tamponade, suturing remains the preferred approach to maintain a stable IOP postoperatively. No cases of hypotony or choroidal detachment were observed in this study cohort. One of the strengths of this study is that we emphasized the comfort of the vitreoretinal surgeon when using the instrument. Ensuring a surgeon’s comfort during vitrectomy is crucial for optimizing surgical performance and patient outcomes. Comfortable surgeons can maintain the precision and stability required for delicate procedures, thereby reducing the risk of complications. As surgeons are at a high risk of work-related musculoskeletal disorders, an instrument that can improve the comfort of ophthalmologists during surgery can also reduce the risk of musculoskeletal disorders for surgeons, thereby extending their professional career. 14 In this study, the short-probe vitrector had high overall comfortability (4.6 out of 5) rated by the retinal surgeon. This study has several limitations. The small sample size may have limited the generalizability of our findings. Pediatric retinal diseases requiring surgical intervention are inherently rare. Second, the follow-up duration was only six months, which was relatively brief. Nevertheless, complications related to surgical instruments typically occur in the early postoperative stages, whereas latent complications are less likely to be directly associated with surgical instruments. In this study, no immediate intraoperative or postoperative complications during the clinical follow-up. Finally, this study did not compare the outcomes of 25-gauge vitrectomy with those of 23- or 27-gauge vitrectomies. A comparative study evaluating different gauge sizes would be valuable to guide the selection of optimal surgical instruments. Future studies with extended follow-up durations are warranted to further assess long-term outcomes. In conclusion, our study investigated the safety and clinical performance of an 18-mm 25-gauge short vitrectomy probe and, to our knowledge, it is also the first study to evaluate the subjective comfort of retinal surgeons. Our findings suggest that this modified vitrectomy probe is safe and effective for pediatric vitrectomy and improves the overall comfort of retinal surgeons, ultimately contributing to the success of pediatric vitreoretinal surgery. Abbreviations BCVA: best-corrected visual acuity CHRPE: congenital hypertrophy of the retinal pigment epithelium IOP: intraocular pressure OCT: optical coherence tomography FA: fluorescein angiography ICG: indocyanine green angiography Declarations Competing Interests : The authors declare that they have no competing interests Funding: The authors declare that they have no conflicting interests. This study received no funding support from Alcon. Ethics approval and consent to participate The study adhered to the Declaration of Helsinki and was approved by the Institutional Review Board of Chang Gung Memorial Hospital (IRB Registration Number: 202101643A0). The clinical protocol was approved by the Data and Safety Monitoring Plan Committee of Chang Gung Memorial Hospital (DSMP number: 210570008). Written informed consent was obtained from all participants and their parents for the anonymous publication of their data. The study is registered at clinicaltrials.gov (identifier NCT06520410). Availability of data and materials The data analyzed during this study are available on request from the corresponding author, Wei-Chi, Wu. Authors' contributions All authors have participated directly in the planning and execution of the work. MMH: acquisition and analysis of data, drafting and writing the article; HDC, EYK, YHC, LL, ANC, KJC, YSH, CCL: acquisition and analysis of data; WCW: design of the study, acquisition of data, final approval. All authors read and approved the final manuscript. References Gan NY, Lam WC (2018) Special considerations for pediatric vitreoretinal surgery. Taiwan J Ophthalmol 8(4):237–242 Ranchod TM, Capone A (2011) Jr. Tips and Tricks in Pediatric Vitreoretinal Surgery. Int Ophthalmol Clin ; 51(1) Williams GA (2008) 25-, 23-, or 20-gauge instrumentation for vitreous surgery? Eye 22(10):1263–1266 Oshima Y, Wakabayashi T, Sato T, Ohji M, Tano Y (2010) A 27–Gauge Instrument System for Transconjunctival Sutureless Microincision Vitrectomy Surgery. Ophthalmology 117(1):93–102e102 Lai JM, Patel V, Watane A, Fils AJ, Pakravan P, Huang C-Y et al (2022) Mechanical Property Comparison of 23-, 25-, and 27-Gauge Vitrectors across Vitrectomy Systems. Ophthalmol Retina 6(11):1001–1008 Şengül Özdek AB (2023) Ulrich Spandau Pediatric Vitreoretinal Surgery . Springer Ung C, Yonekawa Y, Chung MM, Berrocal AM, Kusaka S, Oshima Y et al (2023) 27-GAUGE PARS PLANA/PLICATA VITRECTOMY FOR PEDIATRIC VITREORETINAL SURGERY. Retina 43(2):238–242 WenTao D, SanMei L, Jie L, Jie Z (2024) Wound healing and postoperative management in paediatric patients following 27-Gauge Transconjunctival Sutureless Vitrectomy for vitreoretinal conditions. Int Wound J 21(4):e14611 Shinkai Y, Oshima Y, Yoneda K, Kogo J, Imai H, Watanabe A et al (2019) Multicenter survey of sutureless 27-gauge vitrectomy for primary rhegmatogenous retinal detachment: a consecutive series of 410 cases. Graefes Arch Clin Exp Ophthalmol 257(12):2591–2600 Lai JM, Patel V, Watane A, Fils AJ, Pakravan P, Huang CY et al (2022) Mechanical Property Comparison of 23-, 25-, and 27-Gauge Vitrectors across Vitrectomy Systems. Ophthalmol Retina 6(11):1001–1008 Kusaka S (2018) Current concepts and techniques of vitrectomy for retinopathy of prematurity. Taiwan J Ophthalmol ; 8(4) Gonzales CR, Singh S, Schwartz SD (2009) 25-Gauge vitrectomy for paediatric vitreoretinal conditions. Br J Ophthalmol 93(6):787–790 Shah PK, Prabhu V, Narendran V (2018) Outcomes of transconjuctival sutureless 27-gauge vitrectomy for stage 4 retinopathy of prematurity. World J Clin Pediatr 7(1):62–66 Epstein S, Sparer EH, Tran BN, Ruan QZ, Dennerlein JT, Singhal D et al (2018) Prevalence of Work-Related Musculoskeletal Disorders Among Surgeons and Interventionalists: A Systematic Review and Meta-analysis. JAMA Surg 153(2):e174947–e174947 Additional Declarations The authors declare no competing interests. Cite Share Download PDF Status: Posted Version 1 posted 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. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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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-7173130","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":488251141,"identity":"0119bf15-ee20-47ff-9af4-88920a1ab9f0","order_by":0,"name":"Margaret Ming-Chih Ho","email":"","orcid":"","institution":"Jen-Ai Hospital Dali Branch","correspondingAuthor":false,"prefix":"","firstName":"Margaret","middleName":"Ming-Chih","lastName":"Ho","suffix":""},{"id":488251142,"identity":"4f30605f-c5c4-4cfb-906c-95073f2877d7","order_by":1,"name":"Hung-Da 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traditional vitrectomy probe (left).\u003c/p\u003e","description":"","filename":"Figure1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7173130/v1/9da5315a09110e4f28d1a901.jpg"},{"id":87663838,"identity":"561adcca-e3a5-47f1-961b-326f25a1bb71","added_by":"auto","created_at":"2025-07-27 10:54:45","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":72071,"visible":true,"origin":"","legend":"\u003cp\u003eThe overall comfort, reliability, smoothness during the surgery, ease of instrument rotation, ease of extending to the peripheral retina of the instrument, and ease of eyeball rotation of the 18-mm 25-gauge short vitrectomy probe were rated by the surgeon.\u003c/p\u003e","description":"","filename":"Figure2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7173130/v1/bb695df25dc48b330c1b2bcf.jpg"},{"id":87665149,"identity":"87c639f2-5a2a-4056-a4f2-a471303a8165","added_by":"auto","created_at":"2025-07-27 11:02:45","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":567998,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7173130/v1/66229e0e-293c-4711-ae21-6a9470ab0ade.pdf"}],"financialInterests":"The authors declare no competing interests.","formattedTitle":"\u003cp\u003e\u003cstrong\u003eClinical Performance of 18-mm Short Vitrectomy Probe for Retinal Surgery in Pediatric Patients\u003c/strong\u003e\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003eWith advancements in small-gauge vitrectomy, an increasing number of pediatric vitreoretinal diseases can be effectively treated with intraocular surgery. However, pediatric vitreoretinal surgery presents unique challenges owing to anatomic and physiologic differences from adult eyes.\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e The pediatric eye has a smaller axial length and a thicker lens, making intraocular maneuvers more challenging and increasing the risk of intraoperative complications compared to adult vitrectomy. Additionally, the posterior vitreous firmly adheres to the retina, increasing the risk of iatrogenic retinal breaks when inducing posterior vitreous detachment. The greater elasticity of the pediatric sclera further complicates surgical precision by allowing excessive instrument mobility.\u003c/p\u003e\u003cp\u003eTraditional 20- and 23-gauge vitrectomy probes are not optimized for pediatric eyes, posing maneuverability challenges, increasing surgical time, and increasing the risk of complications such as retinal damage, iatrogenic breaks, or detachment.\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e While smaller-gauge vitrectors, such as 27-gauge vitrectors, improve intraocular stability during surgery and reduce the need for wound suturing, finer gauges are more flexible, making instrument control more difficult due to increased susceptibility to bending.\u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e Furthermore, the conventional 34-mm vitrector is designed for adult eyes and is often impractical in pediatric cases because of its excessive length. Surgeons must alter their grip and hand positioning, which can be obstructed by a child’s nose, further complicating intraoperative control. Additionally, an excessive probe length increases the risk of inadvertent macular or choroidal injury, even with minor hand movements.\u003c/p\u003e\u003cp\u003eAlternatively, an 18-mm \u003cb\u003e(\u003c/b\u003eFig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e\u003cb\u003e)\u003c/b\u003e short vitrectomy kit was specially designed for pediatric retinal surgeries. With a short length of 18 mm, this vitrectomy probe may be more effective and safer for pediatric surgeries. This study aimed to investigate the safety, effectiveness, and reliability of using an 18-millimeter short vitrectomy probe for pediatric vitreoretinal surgery.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e This study adhered to the Declaration of Helsinki and was approved by the Institutional Review Board of Chang Gung Memorial Hospital (IRB Registration Number: 202101643A0). The clinical protocol was approved by the Data and Safety Monitoring Plan Committee of the Chang Gung Memorial Hospital (DSMP number: 210570008). Written informed consent was obtained from parents and legal guardians. This study was registered at ClinicalTrials. gov (NCT06520410).\u003c/p\u003e\u003cp\u003e\u003cem\u003eEligible Criteria\u003c/em\u003e\u003c/p\u003e\u003cp\u003eIn this prospective study, we recruited patients under 18 years of age who underwent vitrectomy due to variable etiologies, including retinopathy of prematurity, familial exudative vitreoretinopathy, persistent fetal vasculature, congenital cataract, lens dislocation, open-globe injury, vitreous hemorrhage, or other vitreoretinal diseases in children, at Chang Gung Memorial Hospital, Linkou branch, from 1st March, 2022 and 28th February, 2024. Clinical characteristics including age, sex, clinical diagnosis, and surgical indication were recorded. Comprehensive preoperative ocular examinations included best-corrected visual acuity (BCVA), intraocular pressure (IOP), slit-lamp biomicroscopy, optical coherence tomography (OCT), fluorescein angiography (FA) and indocyanine green angiography (ICG), color fundus and external eye photography, ocular ultrasonography, and ocular biometry will be obtained before operation. Patients who were unable to cooperate during the ophthalmic examinations or those with implanted defibrillators or pacemakers were excluded from the study.\u003c/p\u003e\u003cp\u003e\u003cem\u003eVitrectomy\u003c/em\u003e\u003c/p\u003e\u003cp\u003eAll vitrectomies were performed by a single retinal specialist (W.C.W.) using 18-mm short vitrectomy kits (Alcon, Switzerland). The intraoperative use of indocyanine green, intraocular tamponade (air, Viscoat, octafluoropropane (C3F8), and sulfur hexafluoride (SF6)), and all other surgical procedures were performed at the discretion of the primary surgeon. The integrity of the short vitrectomy instruments and iatrogenic injuries, including lens touch and retinal damage, will also be documented. The surgeons completed a questionnaire regarding the overall reliability and comfort of using the 18 mm short vitrectomy probe immediately after the operation.\u003c/p\u003e\u003cp\u003e\u003cem\u003eOutcome Measurement\u003c/em\u003e\u003c/p\u003e\u003cp\u003eThe primary outcome measures were the safety of the instrument, including the durability and incidence of iatrogenic complications such as lens touch and retinal injury. The secondary outcome measures included the overall comfort and reliability of the instrument during surgery, as assessed by the retinal surgeon. The safety of the instrument includes the durability and incidence of iatrogenic complications, such as lens touch and retinal injury. Ocular examinations, including BCVA, IOP, OCT, FA, ICG, fundus and external eye photography, ocular ultrasonography, and ocular biometry, were performed at 1, 3, and 6 months postoperatively. Additional ophthalmic procedures were documented.\u003c/p\u003e\u003ch2\u003eStatistical analysis\u003c/h2\u003e\u003cp\u003eContinuous variables are presented as means and standard deviations, and were compared using a \u003cem\u003et\u003c/em\u003e-test. The Chi-square test was used to examine associations between categorical variables. Commercial software (IBM SPSS 24, Armonk, NY: IBM Corp.) was used for all data analyses. A \u003cem\u003ep-value\u003c/em\u003e less than 0.05 was considered statistically significant.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e presents the demographic and surgical details of the study cohort. Sixteen children (18 eyes; 9 male and 7 female patients) undergoing vitrectomy were enrolled. The mean age of our study cohort was 4.9\u0026thinsp;\u0026plusmn;\u0026thinsp;4.3 years old. Surgical indications included persistent fetal vasculature (n\u0026thinsp;=\u0026thinsp;5, 28%), retinopathy of prematurity (n\u0026thinsp;=\u0026thinsp;4, 22%), rhegmatogenous retinal detachment (n\u0026thinsp;=\u0026thinsp;4, 22%), optic pit maculopathy (n\u0026thinsp;=\u0026thinsp;2, 11%), dense capsular opacity (n\u0026thinsp;=\u0026thinsp;2, 11%), and congenital hypertrophy of the retinal pigment epithelium (CHRPE, n\u0026thinsp;=\u0026thinsp;1, 6%). Two patients were excluded during the clinical trials. One patient was excluded because of death from pulmonary hypertension, kidney failure, or septic shock. The cause of death was not associated with an ocular pathology or retinal surgery. Another patient was excluded because the family decided to cancel the surgery and withdraw from the study. Surgical details of each patient are presented in \u003cb\u003eSupplemental 1.\u003c/b\u003e Vitrectomy was performed in all patients; five patients underwent combined lensectomy and two patients underwent combined tractional membrane removal. The mean surgical time was 2.6\u0026thinsp;\u0026plusmn;\u0026thinsp;1.4 h. No incidences of instrument bending, iatrogenic retinal injury, or other complications occurred during any of the procedures. No immediate intraoperative or postoperative complications such as endophthalmitis, postoperative hypotony, choroidal detachment, or ocular hypertension occurred during the postoperative 6-month clinic follow-up. Sixteen eyes (88.9%) achieved their surgical goals. One patient diagnosed with total retinal detachment had a dense vitreous hemorrhage with retinal detachment after surgery. Another patient diagnosed with optic pit maculopathy still had shallow retinal detachment after surgery. All patients in this study were followed up for at least six months after surgery. The mean follow-up duration was 6.8\u0026thinsp;\u0026plusmn;\u0026thinsp;1.8 months.\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\u003eDemographics in Our Study Cohort\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\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\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePatients, n (eyes)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003e16\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003e(18)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge, yrs, mean (SD)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4.9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e(4.3)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSex, male, n, (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e(63)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLaterality, patient, (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRight\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e(44)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLeft\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e(44)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBilateral\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e(13)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDiagnosis, eyes, (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePersistent fetal vasculature\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e(28)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRetinopathy of prematurity\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e(22)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRhegmatogenous retinal detachment\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e(22)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOptic pit maculopathy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e(11)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDense capsular opacity\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e(11)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCHRPE\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\u003e(6)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSurgical Details\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCombine lensectomy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e(28)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCombine tractional membrane removal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e(11)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGas tamponade\u003csup\u003e\u0026dagger;\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e(28)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSilicone oil tamponade\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e(11)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSurgical duration, hrs, mean (SD)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2.6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e(1.4)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFollow-up duration, mons, mean (SD)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e6.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e(1.8)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"3\"\u003eCHRPE: Congenital hypertrophy of the retinal pigment epithelium\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"3\"\u003e\u003csup\u003e\u0026dagger;\u003c/sup\u003e Two with room air tamponade, one with SF6 tamponade, one with C3F8 tamponade\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eThe results of the questionnaire regarding the overall reliability and comfort of using the 18 mm short vitrectomy probe are shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e. The instrument received a top rating of 4.8\u0026thinsp;\u0026plusmn;\u0026thinsp;0.3 out of 5 for the overall comfort rated by the surgeon. The reliability and smoothness of the surgery were rated as 5 and 4.9\u0026thinsp;\u0026plusmn;\u0026thinsp;0.2 out of 5, respectively. Average ease of instrument rotation, ease of instrument extension to the peripheral retina, and ease of eyeball rotation were rated as 4.7\u0026thinsp;\u0026plusmn;\u0026thinsp;0.7, 3.8\u0026thinsp;\u0026plusmn;\u0026thinsp;0.9, and 4.6\u0026thinsp;\u0026plusmn;\u0026thinsp;0.6 out of 5 points, respectively.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eIn this prospective study involving 16 children (18 eyes) who underwent vitrectomy using an 18-mm 25-gauge short vitrectomy probe, excellent ratings were observed for surgeon comfort and instrument reliability. No major post-operative complications were observed. To the best of our knowledge, this is the first study to evaluate the clinical performance and safety of a 25-gauge short probe vitrector during pediatric surgery. Additionally, this is the first study to assess both the overall comfort of a retinal surgeon and the reliability of the surgical instrument using a structured questionnaire.\u003c/p\u003e\u003cp\u003eThe 18-mm, 25-gauge short vitrectomy probe, specifically designed for pediatric retinal surgery, demonstrated several intraoperative advantages. First, its design enhances surgical safety. Because it is shorter than a traditional vitrector, it reduces the risk of iatrogenic retinal breaks and unnecessary hemorrhage. This is particularly crucial in pediatric retinal surgery, because iatrogenic breaks can lead to severe proliferative vitreoretinopathy, potentially resulting in devastating visual outcomes.\u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e In the present study, no iatrogenic retinal breaks or other major complications were observed. Second, compared with the 27-gauge vitrector, which is commonly used in pediatric surgery,\u003csup\u003e\u003cspan additionalcitationids=\"CR8\" citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e this modified 25-gauge vitrector offers greater stiffness, reducing the likelihood of instrument bending during surgery.\u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e Instrument bending increases the risk of unintended lens damage, which can lead to cataract formation after vitrectomy. Thus, the improved rigidity of the 25-gauge probe may contribute to better surgical precision and outcomes.\u003c/p\u003e\u003cp\u003eSeveral challenges were encountered when using the short-probe vitrector in this study. Owing to its shorter length than that of traditional vitrectors, accessing the peripheral retina is more difficult, as reflected in the surgeons\u0026rsquo; questionnaire responses. This limitation became more pronounced when performing surgery on older pediatric patients with longer axial lengths, such as patients 13 and 16 \u003cb\u003e(Supplemental 1.)\u003c/b\u003e, both of whom were 13 years old. Pediatric surgeons must carefully consider these factors when selecting surgical instruments. Another drawback is instrument rotation. A shorter probe length resulted in a relatively shorter moment arm, making instrument rotation more challenging. Consequently, a greater effort is required to rotate the eyes during surgery. Additionally, the shorter probe amplified the vibrations transmitted to the surgeon\u0026rsquo;s hand, thereby increasing tactile feedback. Increased vibration perception may affect the surgeon\u0026rsquo;s comfort and precision, potentially influencing surgical outcomes. Nevertheless, in this study, we still found a high score (4.6 out of 5) for the overall comfort of the instrument, rated by the surgeon. Finally, a 25-gauge sclerotomy wound may still require suturing to prevent wound leakage and ensure a stable IOP postoperatively. Given that the sclera in children is softer and more elastic than that in adults, achieving a watertight sclerotomy is generally recommended to minimize the risk of postoperative hypotony.\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e However, in vitrectomy using a smaller-gauge probe, such as a 27-gauge probe, suturing of the wound might not be needed.\u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e In our study, all surgical wounds were closed using 7\u0026thinsp;\u0026minus;\u0026thinsp;0 vicryl sutures. Because most cases involve gas or silicone oil tamponade, suturing remains the preferred approach to maintain a stable IOP postoperatively. No cases of hypotony or choroidal detachment were observed in this study cohort.\u003c/p\u003e\u003cp\u003eOne of the strengths of this study is that we emphasized the comfort of the vitreoretinal surgeon when using the instrument. Ensuring a surgeon\u0026rsquo;s comfort during vitrectomy is crucial for optimizing surgical performance and patient outcomes. Comfortable surgeons can maintain the precision and stability required for delicate procedures, thereby reducing the risk of complications. As surgeons are at a high risk of work-related musculoskeletal disorders, an instrument that can improve the comfort of ophthalmologists during surgery can also reduce the risk of musculoskeletal disorders for surgeons, thereby extending their professional career.\u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e In this study, the short-probe vitrector had high overall comfortability (4.6 out of 5) rated by the retinal surgeon.\u003c/p\u003e\u003cp\u003eThis study has several limitations. The small sample size may have limited the generalizability of our findings. Pediatric retinal diseases requiring surgical intervention are inherently rare. Second, the follow-up duration was only six months, which was relatively brief. Nevertheless, complications related to surgical instruments typically occur in the early postoperative stages, whereas latent complications are less likely to be directly associated with surgical instruments. In this study, no immediate intraoperative or postoperative complications during the clinical follow-up. Finally, this study did not compare the outcomes of 25-gauge vitrectomy with those of 23- or 27-gauge vitrectomies. A comparative study evaluating different gauge sizes would be valuable to guide the selection of optimal surgical instruments. Future studies with extended follow-up durations are warranted to further assess long-term outcomes.\u003c/p\u003e\u003cp\u003eIn conclusion, our study investigated the safety and clinical performance of an 18-mm 25-gauge short vitrectomy probe and, to our knowledge, it is also the first study to evaluate the subjective comfort of retinal surgeons. Our findings suggest that this modified vitrectomy probe is safe and effective for pediatric vitrectomy and improves the overall comfort of retinal surgeons, ultimately contributing to the success of pediatric vitreoretinal surgery.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eBCVA: best-corrected visual acuity\u003c/p\u003e\n\u003cp\u003eCHRPE: congenital hypertrophy of the retinal pigment epithelium\u003c/p\u003e\n\u003cp\u003eIOP: intraocular pressure\u003c/p\u003e\n\u003cp\u003eOCT: optical coherence tomography\u003c/p\u003e\n\u003cp\u003eFA: fluorescein angiography\u003c/p\u003e\n\u003cp\u003eICG: indocyanine green angiography\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eCompeting Interests\u003c/strong\u003e:\u0026nbsp;The authors declare that they have no competing interests\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u0026nbsp;\u003c/strong\u003eThe authors declare that they have no conflicting interests. This study received no funding support from Alcon.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study adhered to the Declaration of Helsinki and\u0026nbsp;was approved by the Institutional Review Board of Chang Gung Memorial Hospital (IRB Registration Number: 202101643A0). \u0026nbsp;The clinical protocol was approved by the Data and Safety Monitoring Plan Committee of\u0026nbsp;Chang Gung Memorial Hospital (DSMP number: 210570008).\u0026nbsp;Written informed consent was obtained from all participants and their parents for the anonymous publication of their data. The study is registered at clinicaltrials.gov (identifier NCT06520410).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data analyzed during this study are available on request from the corresponding author, Wei-Chi, Wu.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors' contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors have participated directly in the planning and execution of the work.\u003c/p\u003e\n\u003cp\u003eMMH: acquisition and analysis of data, drafting and writing the article;\u003c/p\u003e\n\u003cp\u003eHDC, EYK, YHC, LL, ANC, KJC, YSH, CCL: acquisition and analysis of data; WCW: design of the study, acquisition of data, final approval. All authors read and approved the final manuscript.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eGan NY, Lam WC (2018) Special considerations for pediatric vitreoretinal surgery. Taiwan J Ophthalmol 8(4):237\u0026ndash;242\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRanchod TM, Capone A (2011) Jr. Tips and Tricks in Pediatric Vitreoretinal Surgery. Int Ophthalmol Clin ; 51(1)\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWilliams GA (2008) 25-, 23-, or 20-gauge instrumentation for vitreous surgery? Eye 22(10):1263\u0026ndash;1266\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eOshima Y, Wakabayashi T, Sato T, Ohji M, Tano Y (2010) A 27\u0026ndash;Gauge Instrument System for Transconjunctival Sutureless Microincision Vitrectomy Surgery. Ophthalmology 117(1):93\u0026ndash;102e102\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLai JM, Patel V, Watane A, Fils AJ, Pakravan P, Huang C-Y et al (2022) Mechanical Property Comparison of 23-, 25-, and 27-Gauge Vitrectors across Vitrectomy Systems. Ophthalmol Retina 6(11):1001\u0026ndash;1008\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eŞeng\u0026uuml;l \u0026Ouml;zdek AB (2023) Ulrich Spandau \u003cem\u003ePediatric Vitreoretinal Surgery\u003c/em\u003e. Springer\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eUng C, Yonekawa Y, Chung MM, Berrocal AM, Kusaka S, Oshima Y et al (2023) 27-GAUGE PARS PLANA/PLICATA VITRECTOMY FOR PEDIATRIC VITREORETINAL SURGERY. Retina 43(2):238\u0026ndash;242\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWenTao D, SanMei L, Jie L, Jie Z (2024) Wound healing and postoperative management in paediatric patients following 27-Gauge Transconjunctival Sutureless Vitrectomy for vitreoretinal conditions. Int Wound J 21(4):e14611\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eShinkai Y, Oshima Y, Yoneda K, Kogo J, Imai H, Watanabe A et al (2019) Multicenter survey of sutureless 27-gauge vitrectomy for primary rhegmatogenous retinal detachment: a consecutive series of 410 cases. Graefes Arch Clin Exp Ophthalmol 257(12):2591\u0026ndash;2600\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLai JM, Patel V, Watane A, Fils AJ, Pakravan P, Huang CY et al (2022) Mechanical Property Comparison of 23-, 25-, and 27-Gauge Vitrectors across Vitrectomy Systems. Ophthalmol Retina 6(11):1001\u0026ndash;1008\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKusaka S (2018) Current concepts and techniques of vitrectomy for retinopathy of prematurity. Taiwan J Ophthalmol ; 8(4)\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGonzales CR, Singh S, Schwartz SD (2009) 25-Gauge vitrectomy for paediatric vitreoretinal conditions. Br J Ophthalmol 93(6):787\u0026ndash;790\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eShah PK, Prabhu V, Narendran V (2018) Outcomes of transconjuctival sutureless 27-gauge vitrectomy for stage 4 retinopathy of prematurity. World J Clin Pediatr 7(1):62\u0026ndash;66\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eEpstein S, Sparer EH, Tran BN, Ruan QZ, Dennerlein JT, Singhal D et al (2018) Prevalence of Work-Related Musculoskeletal Disorders Among Surgeons and Interventionalists: A Systematic Review and Meta-analysis. JAMA Surg 153(2):e174947\u0026ndash;e174947\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"Chang Gung Memorial Hospital","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"18-mm short vitrectomy probe, pediatric retinal surgery, persistent fetal vasculature, retinopathy of prematurity, retinal detachment, vitrectomy","lastPublishedDoi":"10.21203/rs.3.rs-7173130/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7173130/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTo report the surgical outcomes, safety, effectiveness, and reliability of 18-millimeter short vitrectomy probes in pediatric vitreoretinal surgery.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis was a prospective, interventional study. We recruited participants under 18 years of age scheduled for vitrectomy due to various etiologies at Chang Gung Memorial Hospital, Linkou branch, from 2022 to 2025. Comprehensive pre-and postoperative ocular examinations were performed. The primary outcome measures were the safety of the instrument, including the durability and incidence of iatrogenic complications such as lens touch and retinal injury. The secondary outcome measured the overall comfort and reliability of the instrument during surgery, as assessed by a retinal surgeon using a questionnaire.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSixteen children (18 eyes) were enrolled with a mean age of 4.9 ± 4.3 years old. No incidences of instrument bending, iatrogenic retinal injury, or other complications occurred during surgery. The instrument received a top rating of 4.6 out of 5 for the overall comfort rated by the surgeon. Average ease of instrument rotation, ease of instrument extension to the peripheral retina, and ease of eyeball rotation were rated as 4.5 ± 0.7, 4.3 ± 0.9, and 4.6 ± 0.6 out of 5 points, respectively. Sixteen eyes (88.9%) achieved their surgical goals.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe 18-millimeter short vitrectomy probe is a safe and effective surgical instrument for pediatric vitrectomy, which improves the overall comfort of retinal surgeons and ensures success in pediatric vitreoretinal surgeries.\u003c/p\u003e","manuscriptTitle":"Clinical Performance of 18-mm Short Vitrectomy Probe for Retinal Surgery in Pediatric Patients","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-07-27 10:54:40","doi":"10.21203/rs.3.rs-7173130/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"2cb10248-df20-46b9-856d-c331f6bfcd47","owner":[],"postedDate":"July 27th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":51825036,"name":"Ophthalmology"},{"id":51825037,"name":"Surgery"}],"tags":[],"updatedAt":"2025-07-27T10:54:40+00:00","versionOfRecord":[],"versionCreatedAt":"2025-07-27 10:54:40","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7173130","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7173130","identity":"rs-7173130","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}