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Rake
Purpose
To examine the feasibility of the use of a flexible intraocular rake to remove epiretinal membranes (ERM).

Design
Interventional case series.

Methods
A multi-tine flexible intraocular rake was designed. Ten consecutive patients with idiopathic epiretinal membranes underwent vitrectomy and removal of the ERM with the intraocular rake. Outcome measures included intraoperative complications, Early Treatment Diabetic Retinopathy Study visual acuity, rate of recurrent ERM, and rate of persistent cystoid macular edema.

Results
The rake was used successfully to remove the ERM in all cases. Two patients had intraoperative retinal tears. At a mean postoperative follow-up examination of 24 weeks, the visual acuity was improved significantly (20/90 before the operation vs 20/50 after the operation; P < .05). One patient had a recurrent epiretinal membrane.

Conclusion
The flexible intraocular rake appears to be capable of the removal of idiopathic ERM. The increased tolerance for retinal contact that results from the flexible tines may make the rake of value to many vitreoretinal surgeons.

23 Gauge Surgical Instrument
Vitrectomy surgery is typically performed by creating 3 small incisions into the eye through which instruments are placed to perform the maneuvers required to accomplish the surgical goals.  For more than 20 years the standard size of the incision has been 20 gauge (20g).  These incisions require sutures at the end of the surgery to render the incisions water-tight so as to maintain the integrity of the eye.

Recently larger gauge (smaller incision size) surgical systems have been utilized in an attempt to improve various aspects of the surgical procedure.  Currently available vitrectomy systems allow for the creation of smaller (23g) and smallest (25g) incisions in the eye, often obviating the need for sutures and reducing surgical time.  Patients often report less discomfort after a small gauge vitrectomy surgery.  In addition, small gauge surgery can create less post operative astigmatism and a faster visual recovery in many patients.

Your NRI doctor has access to both traditional 20g and small gauge vitrectomy systems and will select the best option for you depending on your surgical needs.  Certain intra-operative maneuvers are more easily performed with small gauge vitrectomy instruments, while others are better suited to standard 20g instruments.  Ask your NRI doctor for more details.