Sir,

We read the article ‘Comparison of 25- and 23-gauge sutureless microincision vitrectomy surgery in the treatment of various vitreoretinal diseases’ with great interest.1 Both systems continue to gain increased acceptance in vitreoretinal surgery, but there are limited data comparing their efficacy and uses. Therefore, we commend the authors on conducting a randomized prospective study comparing these two systems across various diseases.

In their report, the authors omitted an important advantage of 23-gauge microincision vitrectomy surgery (MIVS)—the proximity of the cutter port to the tip. The cutting port of 23-guage MIVS is 30% more proximal to the tip compared with its 25-gauge counterpart (Figure 1). The authors mentioned the 23-gauge system would ‘be better than the 25-gauge technique if more advanced cases, such as those with diabetic traction retinal detachment of moderate degree or worse, cases of early proliferative vitreoretinopathy….were included’.1 We agree with the authors' speculations, but encourage readers to understand the multiple ways in which 23-gauge MIVS may be advantageous in these cases, and the proximity of the cutter port to the tip is crucial.

Figure 1
figure 1

The 23-gauge vitrector port is 30% closer to the tip when compared with the 25-gauge vitrector tip.

Full size image

One of the authors (SKG) has alternatively used 25-gauge and 23-gauge MIVS to obtain transretinal choroidal biopsy (TRCB) for prognosis and diagnosis in choroidal melanoma. TRCB of large tumours poses little challenge, but one's dilemma is regarding the small tumours, the biopsy of which bears the caveat of an insufficient sample or specimen.

The failure of 25-gauge MIVS to consistently provide sufficient TRCB specimens has been previously recognized.2 The proximity of the cutter port to the tip lends 23-gauge MIVS a significant advantage in obtaining TRCB of small tumours. The port's proximity in 23-gauge MIVS can be exploited in other aspects of vitreoretinal surgery, particularly in the delamination and segmentation of fibrovascular membranes in proliferative vitreoretinopathy.

In conclusion, we commend the authors on their contribution, but caution against the article's non-comprehensive technical comparison of these two systems. More research is needed to further elucidate the role of 25- and 23-gauge vitrectors in vitreoretinal surgery. Future investigations may also include development of a new vitrector model combining the advantages of 25-gauge MIVS with the proximal port tip of 23-gauge MIVS.

Conflict of interest

The authors declare no conflict of interest.