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Two‐step oblique incision during 25‐gauge vitrectomy reduces incidence of postoperative hypotony

The efficacy of a two‐step, oblique incision procedure during 25‐gauge vitrectomy on postoperative hypotony was evaluated by a retrospective, case–control study. The transconjunctival incision during 25‐gauge vitrectomy was made in two steps: penetration with a microvitreoretinal blade followed by a penetrater instrument of a blunt trocar. The two‐step procedure was performed on 89 eyes and with the conventional incision on 68 eyes. The incidence of hypotony (intraocular pressure <6 mmHg) on the first postoperative day and after 1 week and 1 month was compared. Hypotony was found in two eyes (2%) with the two‐step method and 12 eyes (18%) with the conventional incision on the first postoperative day (P = 0.001, Fisher's exact probability test). The preoperative intraocular pressure was not significantly different in the two groups but was significantly higher in the two‐step group than in the conventional method group on the first postoperative day (P = 0.001, Wilcoxon rank test). Twenty‐five‐gauge vitrectomy with two‐step oblique incisions will reduce the incidence of postoperative hypotony on the first postoperative day.