p>The subspecialty of retina has changed dramatically in the past several years due to advances in medical therapy for retinal disease. The core focus of most vitreoretinal specialists, however, has traditionally been surgery. This issue of Retina Today focuses on vitreoretinal surgery. In recent years, many changes have occurred in surgery, perhaps the most significant being the migration to small-gauge instrumentation. Early adopters of 25-gauge surgery benefited from smaller incisions, but the technology was limited, and there was a relatively narrow spectrum of procedures that could be performed using microincisions. Additionally, early 25-gauge instruments suffered from the perception that they were too flexible to provide the control that surgeons had become accustomed to with 20-gauge surgery, and dim illumination was a challenge. The addition of 23-gauge instrumentation and expanded availability of 25-gauge instruments, including improved illumination, addressed many of the early limitations and, as a result, adoption of small-gauge technology has been widespread. In this issue, our cover focus includes articles that describe surgical outcomes for vitrectomy, macular hole and macular pucker, as well as discussion on the evolution of the technology and adaptation of techniques to suit these smaller incisions.

The concern over increased rates of endophthalmitis with sutureless microincision surgery is also an area of debate. Based on studies that found a significantly higher rate of endophthalmitis with 25-gauge surgery, the Microsurgical Safety Task Force (MIST) was convened to analyze the risk of endophthalmitis and develop protocols for increasing the safety of small-gauge surgery. We have included an article from one of the task force members to describe the MIST's findings and subsequent recommendations.

Innovation in surgery is occurring at a fast rate. We have better equipment, such as integrated vision systems to improve on our traditional vitrectomy machines, and instrumentation that is specifically designed on the experiences of those who have gained experience and perspective with small-gauge surgery. Interestingly enough, as the debate and discussion continues regarding 23- and 25-gauge surgery, we also feature an article from one of our Japanese colleagues introducing the concept of 27-gauge surgery.

WHAT LIES AHEAD IN SURGERY
The future of vitreoretinal surgery depends on the retina community's ability and desire move forward, both technologically and pharmacologically. Some examples of future innovations include pharmacosurgical therapies (ie, surgical delivery of medical therapy) and the combination of new technologies with existing surgical techniques (ie, real-time intraoperative optical coherence tomography, robotic surgical capabilities, or "heads up" microscope operating capabilities).

We are fortunate to have so many options currently available to us, and it will be interesting and exciting to see what the future of vitreoretinal surgery brings.