الفهرس 
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Abstract
Significant studies in microincisional vitrectomy system fluidics, instrumentation, illumination, and viewing systems have been made in recent years, and MIVS has all but replaced 20G systems for a wide variety of vitreoretinal surgical indications. Retinal specialists have shifted away from 20G systems to smaller sutureless systems that have reduced operative times, surgical trauma, inflammation, astigmatism, and improved patient comfort, postoperative recovery times, and patient satisfaction. This drives the question towards even smaller gauge systems, although this is tempered by the engineering challenges, instrument trade-offs, surgical learning curves, availability, and, importantly, the higher costs. Careful case selection and optimisation of surgical techniques for small gauge systems are important for surgical success. This study is a prospective interventional study. Patients affected by epiretinal membrane (ERM), macular hole (MH), idiopathic vitreomacular traction (VMT) and lamellar macular holes (LMH) underwent surgery between April 2017 and March 2018. All patients were recruited for the study at Vitreoretinal service of Ophthalmology department – ASST Santi Paolo e Carlo hospital - University of Milan. The study adhered to the tenets of the Declaration of Helsinki. The ethical committee approval of the Santi Paolo e Carlo hospital-university of Milan was obtained for this study The study has included 40 patients and their mean age was 71.9 ± 10.3. Males (62.5%) more than females (37.5%) and OS eyes represent 57.5% of total eyes. In regard to lens status, 38 eyes (95%) were pseudophakic, 2 eyes (5%) were phakic. Of the 40 eyes, none underwent concurrent cataract extraction and IOL implantation at the time of vitrectomy surgery. Among studied patients 3 (7.5%) were diabetics. Surgical indications included ERM (n 30), full-thickness macular hole (n 4), Lamellar hole (n 5) and idiopathic VMT (n 1). The main complaint was metamorphopsia (n 16), decreased vision (n 10) or both (n 14). 2 eyes with ERM had previous history of successful scleral buckle procedure for treatment of rhegmatogenous retinal detachment. the mean surgery time was 19.4 ± 4.9 minutes while vitrectomy time was 9.0 ± 2.1 minutes. In 82.5% the dye was used, and all cases have suture. While shaving was in 12.5% of patients. As regards tamponade, air was used in 17.5% of cases and SF6 in 5%. Nearly all patients received peribulbar anaesthesia (97.5%). Only two cases developed intraoperative complications (Iatrogenic retinal break in one eye and haemorrhage from a major vessel during peeling in another one) and both were managed intraoperative. Log MAR VA improved from 0.39 ± 0.19 (0.40 ± 0.17 decimal equivalent) preoperatively to 0.24 ± 0.18 (0.62 ± 0.23 decimal equivalent) at final follow-up (P < 0.001). Statistically significant improvement in logMAR VA at final postoperative visit was noted for ERM (P < 0.001), Lamellar macular hole (P < 0.027). Concerning cases of ERM, the central macular thickness (CMT) decreased significantly from 503.9 ± 113.8 preoperatively to 398.7 ± 91.7 and 361.4 ± 90.7 at postoperative month 3 & 6 respectively (p<0.001).