Work

Long-Shaft Vitrectomy Probe for Vitreoretinal Diseases in Highly Myopic Eyes: A Randomized Controlled Trial

Year: 2025

Type: article

Study designs: Randomized Controlled Trial, Clinical Trial

Abstract: Objectives To evaluate the safety and efficacy of a long-shaft vitrectomy probe in highly myopic eyes undergoing pars plana vitrectomy (PPV). Design Randomized controlled trial Subjects Highly myopic eyes (axial length > 26 mm) with epiretinal membrane, myopic tractional maculopathy, and retinal detachment Methods The enrolled eyes were randomly assigned into a study group (UltraVit 25 Ga, 31.75 mm, Alcon) and a control group (UltraVit 25 Ga+, 27 mm, Alcon). Stratified randomization was performed to balance the proportion of eyes with axial length > 28 mm between groups. Main Outcome Measures Trocar removal rate and core vitrectomy time were assessed as primary outcomes and instrument bending as a secondary outcome. Anatomical and visual outcomes and complications were documented for six months. Subgroup analysis was performed to compare the eyes with axial length longer than 28 mm than those without. Results We included 86 patients with mean age of 60.7±9.6 years and AL of 29.15±2.14 mm. Two groups had comparable core vitrectomy times (-0.5 minutes, P=0.172). The study group had a lower trocar removal rate (5 vs. 67%, P < 0.001) but a higher instrument bending rate (36 vs. 14%, P=0.036), particularly in eyes with AL > 28 mm. In eyes with AL > 28 mm, the standard vitrectomy probe faced significantly greater difficulty in cortical vitreous removal, internal limiting membrane trimming, or posterior vitreous detachment induction compared to the long-shaft vitrectomy (P < 0.001). At 6 months, significant visual improvement and anatomical success were achieved. (study: -0.22, 95%; control: -0.24, 88%). Eyes with epiretinal membrane in the study group, not the controls, had significant visual improvement (-0.21, P=0.02 vs. -0.09, P=0.34). Conclusion The long-shaft vitrectomy probe is safe and efficient, especially in highly myopic eyes with axial length exceeding 28 mm, despite a higher instrument bending rate. It provides improved access to the posterior pole, allowing for delicate removal of adherent cortical vitreous and trimming of internal limiting membrane flaps. Addressing increased instrument bending due to the sleeveless design is important for future design.

Source: Ophthalmology Science

DOI: 10.1016/j.xops.2025.100824