Twenty-five-gauge sutureless vitrectomy has been increasing in popularity. In conjunction with this surge, however, is the observation that the procedure is associated with increased postoperative complications such as hypotony, choroidal detachment, and an increased incidence of endophthalmitis. Richard Kaiser, MD, from the Retina Service of Wills Eye Institute, Philadelphia, focused on endophthalmitis and noted that the 25-gauge procedure has a risk of infection that is 12.4 times greater than the 20-gauge procedure.

In light of this, the Micro-Surgical Safety Task Force, composed of experienced retina surgeons, undertook the task of disseminating guidelines to reduce the high rate of endophthalmitis associated with 25-gauge vitrectomy.

Regarding ocular preparation, task force members suggested that the lidocaine gel should be rinsed off the ocular surface to allow direct contact of povidone iodine 10% with the conjunctiva.

Intraoperatively, all members of the task force agreed on the following:

• Conjunctival displacement is important with a cotton tip rather than instruments such as forceps or a caliper, thus facilitating conjunctival displacement without causing microholes.
• Angled incision may be advantageous over straight-entry incisions because of improved wound closure and for maintaining the initial postoperative IOP level.
• Use of antibiotics are important at the end of the case and postoperatively, but the location varied by surgeon and gentamicin should be avoided because of the potential for toxicity.
• An air-fluid exchange at the end of the case may be superior to filling eyes with fluid, which seem to have a high risk of developing endophthalmitis, and IOP can be maintained.
• Using a tapered exit may eliminate vitreous incarceration in the wound that can occur when the trocar is pulled straight out as the result of a suction effect.
• Surgeons should maintain a low threshold for placing a suture at the end of the case.