Comparison of 27-Gauge 20,000 vs. 10,000 cuts per minute vitrectomy systems in epiretinal membrane surgery: a randomized clinical trial

Recent advances in 27-gauge vitrectomy technology have led to the development of 20,000 cuts-per-minute (CPM; 20 K) systems aimed at enhancing surgical efficiency. While experimental data suggest that higher cutting rates may improve vitreous removal, clinical evidence directly comparing 20 K and 10 K (10,000 CPM) systems remains limited. This study compared the efficacy and safety of 27-gauge vitrectomy systems operating at 20 K versus 10 K in epiretinal membrane (ERM) surgery. In a single-center, single-masked, prospective randomized clinical trial, 66 eyes with idiopathic ERM were assigned to either the 20 K group (n = 33) or the 10 K group (n = 33). Patients with secondary ERM, prior vitreoretinal surgery, or coexisting retinal disease were excluded. Surgeries were performed by five retinal surgeons, with randomization stratified by surgeon. The 20 K group underwent surgery using the HYPERVIT® cutter (Alcon Inc., Fort Worth, TX, USA), while the 10 K group was treated with the Advanced ULTRAVIT® cutter (Alcon Inc.). The 20 K group showed a notable reduction in vitrectomy time compared to the 10 K group. There were no significant differences in observed adverse events, as well as visual and anatomical outcomes. These findings suggest that the 20 K system improves surgical efficiency.