23–Gauge Sutureless Transconjunctival Vitrectomy

Abstract

Abstract: : Purpose: To describe our initial results with 23–gauge sutureless transconjunctival pars plana vitrectomy. Methods: We performed a retrospective review of 12 eyes of 12 consecutive patients who underwent 23–gauge sutureless transconjunctival pars plana vitrectomy using a system developed by Dutch Ophthalmic Research Center (DORC). Indications for surgery included macular hole (4 eyes), vitreomacular traction syndrome (2 eyes), tractional retinal detachment (2 eyes), vitreous hemorrhage (2 eyes), rhegmatogenous retinal detachment (1 eye), and retained lens fragment (1 eye). Functional flexibility of 20, 23, and 25–gauge instruments were evaluated. Results: The immediate surgical goal was accomplished in all cases without intraoperative complication. All types of 23–gauge instruments were sturdier and more versatile than 25–gauge and allowed for sutureless procedures to be performed on more complex retinal pathology. Only one sclerotomy site (3%) required suturing. No cases of postoperative hypotony were seen. Mean postoperative intraocular pressure (IOP) on postoperative day 1 was 19 mmHg. Postoperative discomfort was less than traditionally seen with 20–gauge vitrectomy and comparable to 25–gauge vitrectomy. 23–gauge trochars were more difficult to place than 25–gauge systems and often caused a small subconjunctival hemorrhage upon removal. Wound closure for 23–gauge sclerotomies was superior to 25–gauge sclerotomies. Conclusions: 23–gauge sutureless transconjunctival pars plana vitrectomy is an effective surgical procedure for selected diseases of the posterior segment. It provides an alternative to 20–gauge and 25–gauge vitrectomy. The technique combines the benefits of minimally invasive transconjunctival surgery without some limitations of 25–gauge surgery. Sturdier instrumentation and better handpiece flow parameters allow for an expanded spectrum of surgical indications.

Keywords: vitreoretinal surgery