Training Experience with Sutureless 23-Gauge Pars Plana Vitrectomy: My First 99 Sclerotomies

Abstract

Purpose: : The recently developed sutureless 23-Gauge (G) pars plana vitrectomy surgery is considered to be more efficient and beter tolerated than conventional 20-G vitrectomy. We report data showing excellent safety profile of 23-G vitrectomy surgery performed in the training setting with, however, a significant rate of would leakage warranting suturing.

Methods: : A prospective study of 35 consecutive cases of 23-G vitrectomy surgery performed at a teaching institution was conducted. All cases were performed by a single retina fellow without any prior experience with 23-G vitrectomy under the supervision of multiple attendings.

Results: : Leakage was observed in 10 cases (28.5%), total of 18 sclerotomies (18.1%). In cases of combined 23-G and 20-G vitrectomy (5 of 35 cases), where sclerotomy ports were enlarged to accommodate 20-G instrumentation or facilitate removal of intraocular foreign bodies, none of the 23-G wounds required suturing. No learning curve was noted regarding wound leakage for use of sutureless vitrectomy technology, with early results comparable to later ones. 2 out of 9 eyes with air or gas tamponade had leaking wounds which required suturing at the time of surgery, compared with 8 out of 26 with no tamponade (p=0.63). There was no correlation between the dominant hand sclerotomy site and the rate of wound leakage. The infusion sclerotomies had a lower rate of leakage compared with active superior sclerotomies (3/18 total) (p<0.05). Perioperative conjuctival cystic changes and "ballooning" associated with unsutured wounds did not correlate with the level of postoperative intraocular pressure (IOP). No complications occurred perioperatively or post-operatively. Two patients developed significant postoperative hypotony (IOP < 6.5mmHg) with no long-term sequelae. Average follow-up was 9.5 months.

Conclusions: : Trainees can safely perform sutureless 23-G vitrectomy surgery. However rates of wound leakage truthfully reported are higher than those reported in the literature. This is suggestive of a learning curve in a training environment with multiple techniques used, may reflect low threshold for suturing sclerotomies, or represent weaknesses of the single step preloaded transconjuctival vitrectomy system.

Keywords: retina • vitreoretinal surgery