Abstract: Vitreous surgery is a microsurgery developed in the early 1970s, and its emergence is considered a major revolution in the history of ophthalmic treatment. With the development of surgical instruments and the accumulation of experience, the indications for surgery have been expanded, and the scope of surgery has been extended to almost the entire eye except for the cornea and sclera, enabling the cure of many eye diseases that were considered incurable in the past. In developed countries, vitreous surgery has become the second major ophthalmic surgery after cataract surgery. This article reviews the history of vitreous surgery and highlights the rapid development of minimally invasive vitreous surgery in recent years. Keywords: vitreous surgery; minimally invasive; review Vitreous surgery was first introduced more than 100 years ago. Prior to this time, the vitreous was considered off-limits to ophthalmologists. At that time, ophthalmologists were at their wits’ end when faced with a patient blinded by vitreous hemorrhage or inflammation, forcing ophthalmologists to focus on this off-limits area. Is the vitreous really inaccessible? How did surgery in the vitreous cavity travel and evolve before and after the birth of Machemer’s (1971) classic vitrectomy? Vitreous replacement The first bold application of vitreous aspiration as a treatment for a patient with long-term vitreous opacity to perform vitreous surgery to restore the patient’s vision was a pioneering move that disproved the argument that the vitreous was off-limits and announced the beginning of the budding phase of vitreous surgery, followed by Deutschmann (1906), Komoto (1910), Elschning ( (1911), Hagner (1927), and Cutler (1946) took vitreous aspiration a step further based on Ford: they used calf serum and rabbit vitreous (Deutschmann), saline (Komoto), air (Elschning), cerebrospinal fluid (Hagner), human vitreous (Cutler) This was the earliest prototype of vitreous surgery, which paved the way for the development and renovation of vitreous surgery in the future. In the late 1990s, the improvement and enhancement of intraocular surgical instruments began to take a glorious step forward in vitreous surgery: Mamoli (1946) and Dellaporta (1954) treated macular fissures with a transvitreal electrocoagulator, and Scheperns (1951) designed a bimanual indirect ophthalmoscope worn on the head, offering the possibility of vitreous surgery under direct vision. freeman Mklaelsom (1960) mentioned the use of slit lamp illumination for vitrectomy, and Smith (1967) described the application of an operating microscope and contact lens for vitreous surgery. This in which good intraocular illumination is a prerequisite for performing open vitrectomy. Throughout the history of vitreous surgery, the solution of intraocular illumination was a key point that enabled the rapid development of vitreous surgery in the later years. In the late 1960s, David Kasner performed a vitrectomy on a patient with vitreous amyloidosis and was surprised to find that the patient tolerated most of the vitreous loss [1], leading to the concept of open sky vitrectomy, which cured some complex cases previously thought to be impossible. However, corneal dissection, crystal removal, zero intraocular pressure, etc. overshadowed open vitreous surgery and limited its application and development. From the 1970s onwards, vitreous surgery entered a phase of rapid development, and the greatest contribution of this period was made by Machemer, who was the first to use a closed pars plana vitrectomy [2], in contrast to open surgery, with significantly less tissue damage and surgical complications, and with stable intraocular pressure from start to finish. Initially, Machemer used a 17G (1.5 mm diameter) vitrectomy multifunctional instrument. In 1972, O’Malley, Heintz [3] designed the smaller 20G (0.9 mm diameter) vitreous suction cutter (VISC) with a catheterized fiberoptic light source, which was most characteristic of this new procedure. In 1972, O’M alley, Heintz [3] designed a smaller 20G (0.9 mm diameter) vitreous cutting head, and this less damaging three-port pars plana vitrectomy (TPPV) system has been used ever since. With advances in technology and instrumentation, the closed transciliary flat vitrectomy has become the classic procedure for vitreous surgery. After 30 years of matured closed vitrectomy, retinal surgeons are quite aware of the problems of this surgical approach: the complexity of the operation, the difficulty of the procedure, the trauma and uncertainty of the outcome, and the long recovery time of the patient after the surgery. Experts recognized that the key to solving these problems was to change some of the methods of traditional vitrectomy surgery, i.e., like cataract extraction, the new style brought minimal surgical trauma. So a new surgical concept began to challenge retinal surgeons: could vitrectomy be as simple and fast as cataract surgery, without sutures, for the entire procedure? Fujii designed a minimally invasive vitrectomy system with a slimmer and smaller microsurgical instrument called the 25G (0.5 mm diameter) transconjunctival sutureless vitrectomy system (TVS) [4]. TVS) [4]. This system breaks away from the previous 20G vitrectomy procedure by using a 25G trocar to directly puncture the bulbar conjunctiva and sclera into the vitreous cavity, quickly creating the 3 channels needed for the procedure and placing temporary cannulas on the channels. Because of the small diameter of both the trocar needle and the surgical instruments, only a small hole is required to pass through the bulbar conjunctiva and sclera, and the conjunctival and scleral wounds can close on their own after trocar removal, thus achieving the goal of sutureless surgery and making the procedure less invasive. Nowadays, the 25G transconjunctival sutureless vitreous system has been developed and followed by 23G and 27G minimally invasive vitreous surgery systems, which have been clinically used. 2007 Hubschman et al. proposed the concept of combined 25G and 23G system [5], where two 25G channels are used for perfusion and light source and one 23G channel is used for vitreous cutting head and other surgical instruments, with good results. Rizzo et al [6] improved the incision puncture and designed an oblique-parallel insertion (OPAI) parallel to the scleral fibers, which changed the vertical puncture to an angled incision and completely reduced the complications of poor closure of the scleral incision in minimally invasive vitreous surgery. In addition to the improvement of incision size and direction, the number of incisions has also become smaller as the technique has matured, resulting in minimal surgical trauma. Colucciello et al. used a two-channel transciliary flat vitrectomy instead of the traditional three-channel procedure and successfully removed vitreous blood accumulation due to retinal neovascularization in 12 diabetic patients with safe, rapid surgery, few complications, and good postoperative visual recovery. 2009 Gualtieri et al [8] successfully applied the 25G system to perform the least invasive single-channel transciliary vitrectomy to date. The least invasive one-port pars plana vitrectomy (OPPPV) for vitreous, macular and vitreomacular junction disease was performed with the 25G system. The procedure is effective, with a low incidence of postoperative retinal detachment and endophthalmitis, and the procedure is comfortable and short, and can be done on an outpatient basis. In addition, the surgical instruments are constantly improved and improved, such as the use of wide-angle lenses with larger field of view, the use of xenon light sources and ceiling lights to improve the lighting system, and the realization of a truly two-handed operation. Three sizes of minimally invasive vitreous surgery systems will be the future of vitrectomy development. Conclusion and outlook Vitreous surgery, after nearly half a century of historical changes, has developed its own system. As one surgical hurdle after another has been broken through, many of the difficulties of the early days no longer exist, but vitreous surgery still retains its unique appeal, and the procedural process will always contain a powerful challenge and fascination. With the perfect combination of high-end technology and superb medical skills, once incurable conditions can be accomplished in a short period of time. Vitreous surgery is still evolving at a rapid pace, with the expansion of the surgical area into the macula and the development of new instruments, all of which are new goals for scholars to pursue.