Micro Incision Vitrectomy Surgery (MIVS): An Overview

Introduction In today’s world of nano-technology where bigger no longer means better, everything from smartphones to surgical incisions are getting smaller and more refined. The advantages of smaller surgical incision have resulted in faster postoperative recovery. Vitreoretinal surgery is no exception. We have come a long way since the time of open sky vitrectomy and Machemer’s first 17-gauge closed pars plana vitrectomy (PPV) in 1971. In 1974, O’Malley and Heintz introduced a smaller 20-gauge (G) vitrector (0.9 mm diameter) for use with the three-port sclerotomy system that became the gold standard for modern PPV and has been the standard of care for almost three decades. However, in current times, just attaching the retina is not enough. Variables like patient comfort (both intra and post-operative), surgical time and precision, post-operative recovery time, surgically induced refractive error, cosmesis, etc. are becoming increasingly important. To take these factors into account, ‘Transconjunctival sutureless vitrectomy’ (TSV), subsequently renamed and popularly known as microincision vitrectomy system (MIVS) has come about. The 25-gauge vitrectomy was introduced in 2002 by Fujii et al followed by the 23 gauge in 2005 by Eckardt and Stanley Chang which combined the benefits of 20 and 25 gauge. In 2010, Oshima introduced even smaller, 27-gauge instrumentation. As a result of these advances, vitreoretinal surgeons now have multiple choices when determining their operative approach. In this article, we would like to give a brief overview of the various MIVS systems available.