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Renaud Duval, Kourous A. Rezaei; Rate of Suturing in 23-gauge and 25-gauge Primary Vitrectomy. Invest. Ophthalmol. Vis. Sci. 2012;53(14):2596.
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© ARVO (1962-2015); The Authors (2016-present)
To evaluate the rate of sclerotomy suturing in a large series of primary small-gauge vitrectomies.
Retrospective chart review of 23-gauge and 25-gauge transconjunctival vitrectomies performed between 2008 and 2011 in a multi-surgeon retina practice. Patients with previous history of retinal surgery, combination of vitrectomy and scleral buckling surgery, or intra-operative conversion of a sclerotomy to 20-gauge were excluded from this study. Vitrectomies were divided into two types according to their degree of complexity and intra-operative utilization of instrumentation. Type 1 vitrectomies used limited instrumentation (vitreous cutter and light pipe in all cases; soft tip cannula and/or endolaser probe in selected cases), while type 2 vitrectomies used more extensive instrumentation. Each patient’s operative report was reviewed and the rate of sclerotomy suturing was recorded.
A total of 329 eyes from 312 patients were included in this study. The average age was 64.6 years and there were 181 women (55.0%) and 148 men (45.0%). At least 1 sclerotomy was sutured in 189 eyes (57.4%): 1 sclerotomy was sutured in 51 eyes (15.5%), 2 sclerotomies were sutured in 35 eyes (10.6%) and 3 sclerotomies were sutured in 98 eyes (29.8%). The superotemporal, superonasal and inferotemporal (infusion) sclerotomies were respectively sutured in 144 (43.8%), 140 (42.6%) and 131 (39.8%) of cases (no statistically significant difference, p=0.574). In the presence of air/gas tamponade 52.4% of the eyes required at least one sclerotomy sutured; however, in fluid filled eyes 63.9% of the eyes requires the suturing of at least one sclerotomy. This difference was statistically significant (p=0.0432). Dividing the vitrectomies by complexity level yielded the following sclerotomy suturing rates when all 987 sclerotomies were analyzed individually: 299 out of 759 (39.4%) sclerotomies were sutured in type 1 vitrectomies vs 116 out of 228 (50.1%) for type 2 cases, a statistically significant difference (p=0.0022).
Our series had an overall sclerotomy suturing rate of 57.4%. Air/gas tamponade significantly decreased the suturing rate in primary small-gauge vitrectomies. While the location of the sclerotomy did not have a significant effect, more complex surgeries tended to be associated with a higher rate of sclerotomy suturing. Further studies are required to better understand the factors that impact the rate of suturing in small gauge surgery.
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