23-Gauge Transconjunctival Sutureless Pars Plana Vitrectomy in Different Posterior Segment Diseases: Complications and Visual Outcomes

Abstract

Purpose: : To evaluate the effectiveness, visual outcomes and complications of the transconjunctival sutureless pars plana vitrectomy for several posterior segment diseases in our Retina Section.

Methods: : A retrospective chart review of 75 consecutive 23 gauge vitrectomy cases done by the vitreoretinal surgeons of our staff. All surgeries were performed using the two step 23 gauge system. The indications for surgical intervention were diabetic vitreous hemorrhage (DVH) (n = 30), rhegmatogenous retinal detachment (RRD) (n = 18: 12 pseudophakic, 6 phakic), traumatic retinal detachment and PVR (n = 3), macular epiretinal membrane (MEM) (n = 11), macular hole (MH) (n = 4), endophthalmitis (n = 2), and vitreous hemorrhage secondary to branch retinal vein occlusion (BRVO) (n = 7). All patients had at least a 6-month follow-up. Main outcome measures included visual acuity (VA), intraocular pressure (IOP), and operative complications.

Results: : Mean overall VA was counting fingers (range light perception to 0.3) preoperatively and 0.2 (range 0.1 to 0.8) postoperatively (p = 0.001). Statistically significant VA improvement was observed in eyes with DVH, RRD, MEM, MH endophthalmitis, BRVO and PVR cases. Mean IOP was 18.2 mmHg (range 10 to 26 mmHg) preoperatively and 15.4 mmHg (range 10 to 20 mmHg) at 2 months postoperatively. Worrisome complications were 3 cases of hypotony occurrying on day 1 and 2 cases of pseudophakic retinal detachment that recurred.

Conclusions: : 23 gauge transconjunctival sutureless vitrectomy is an effective and safe surgical technique in the management of vitreoretinal diseases. This minimally invasive and completely sutureless technique appears to decrease the operating time and improve patient comfort.

Keywords: vitreoretinal surgery • retinal detachment • vitreous