Q&A: Brandon D. Ayres, MD, on streamlining anterior vitrectomy with a high-speed, small-gauge probe at ASCRS 2025

Brandon D. Ayres, MD, discusses the benefits of a trocar-free, high-speed 27-gauge vitrector in improving efficiency and safety during anterior vitrectomy, as presented at ASCRS 2025. (Image credit: AdobeStock/frender)

Brandon D. Ayres, MD, highlighted the clinical benefits of using a 27-gauge, 22,000-cpm vitrectomy probe for pars plana anterior vitrectomy in his presentation at the 2025 American Society of Cataract and Refractive Surgery annual meeting, held April 25–28 in Los Angeles, California. Ayres, who is from the Cornea Services at Wills Eye Hospital in Philadelphia, Pennsylvania, and the Ophthalmic Partners of Pennsylvania in Bala-Cynwyd, provided further insights in this interview with Ophthalmology Times.

Transcript edited for clarity.

Ophthalmology Times: What are the clinical advantages of using a 27-gauge, 22,000-cut-per-minute vitrectomy probe for pars plana anterior vitrectomy?

Ayres: Most anterior segment surgeons only have access to 23-gauge vitrectomy instrumentation with lower cut rates. These vitrectors are also often used in conjunction with a trocar to improve access through the pars plana. The majority of anterior segment surgeons are not familiar with placement of a trocar, nor are they comfortable with suture closure of the incision site once the trocar is removed. Several colleagues and I have been using a 510(k)-cleared, 27-gauge, sharp needle-tip probe (Vista 1-Step) for pars plana assisted anterior vitrectomy, and I recently presented our findings from a study of 27 eyes treated using this device, with 3-month follow-up.¹ The 27-gauge vitrector does not need a trocar and is much smaller in gauge, allowing it to be used without suture closure. This high cut rate improves ease of vitreous removal and the needle tip of the vitrector eliminates the need for a trocar.

How does this technology impact surgical efficiency and patient recovery times?

Ayres: In our study, surgeons rated the device’s vitreous cutting efficiency better than limbal-based or conventional pars plana devices in 81% of cases, and equivalent to others in the rest. Smaller incisions are less likely to leak and do not need suture closure, leading to improved healing times and reduced patient discomfort.

Are there specific case scenarios where this probe has demonstrated particular benefits or challenges?

Ayres: I have used the 27-gauge vitrector in cases where I knew we would have to deal with vitreous—for example, in a traumatic cataract with vitreous prolapse or when performing an IOL exchange with an open capsule. In these case, the cutter has improved efficiency of the surgery. The only challenge is when the pars plana has to be entered more than once, this vitrector is primarily intended to be placed once through the pars plana, used to remove vitreous, and then removed. I have been able to get the device through the same sclerotome, but the incision is so small it can be hard to find.

How does the smaller gauge and higher cut rate affect intraoperative safety, particularly in terms of traction and iatrogenic retinal breaks?

Ayres: In our study, the small gauge provided for watertight closure of the entry wound without the need for suture closure, and the high cut rate provided highly efficient vitreous removal with minimal traction on the retina. We did not see any retinal tears, hemorrhages, detachments, or other retinal complications, which improves patient safety.

What have been the surgical learning curve and handling experiences with this probe compared with traditional vitrectomy systems?

Ayres: This vitrector is different from other vitrectors. The learning curve requires just a few cases. In the study, surgeons rated insertion of the probe into the sclera as “easy” to “very easy” in the majority of cases (59%). Control of IOP is critical for placement of the probe. For entry, the IOP must be elevated to make an efficient needle puncture through the pars plana, and the needle must be perpendicular to the sclera, or the needle can bend. With just a few cases, surgeons will feel confident using the 1-Step 27-gauge vitrector.

Reference

1. Ayres B, McCabe C, Gonzalez VH, Fram N. Safety and performance of a 27-gauge, 22,000-cut-per-minute vitrectomy probe for pars plana anterior vitrectomy. Presented at: American Society of Cataract and Refractive Surgery 2025 Annual Meeting; April 25-28, 2025; Los Angeles, California.