23 ,25 Gauge Suture Less Vitrectomy

Anuj eye Hospital has classically been performed with 20-ga. instruments. How­ever, advancement in techniques and instrumentation led to the introduction of 25-ga. vitrectomy.

Although this has de­creased operative times and has­tened postoperative recovery, some vitreoretinal surgeons have been disappointed with the in­ability to perform complicated surgical maneuvers due to the increased flexibility of the instruments. In response to these concerns, 23-ga.

transconjunctival sutureless vitrectomy has re­cently been developed. In this article, we will review the principles and techniques of this new innovation in vitreoretinal surgery.

A variation on the standard 20-gauge vitrectomy has been described by Gotzaridis17 with the use of conjunctival diathermy rather than peritomy prior to port creation. This technique aims to reduce hemorrhage and surgical time by utilizing an oblique, then perpendicular sclerotomy to create a self-sealing, sutureless wound with overlying conjunctiva, similar to the previously described 23-guage and 25-guage systems. However, it does not utilize cannulae in the port sites.

A 20-guage MVR blade is used with ports large enough to accommodate standard vitreoretinal instruments. In order to maintain the sutureless nature of the procedure, it is advisable to avoid unnecessary instrument exchange which could enlarge the ports.

In a case series of 84 eyes that underwent this technique,17 three patients (3.5%) had hypotony at day one which normalized at day four postoperatively. Two patients had bleb formation and the rest had minor leakage with a flat conjunctiva. There were no differences found in regards to visual acuity, IOP, or inflammation; but this technique was found to offer shorter operative times. Review at two months post surgery revealed the conjunctiva was freely mobile with normal appearance of its vasculature.

More recently, Lafeta et al,18 described a 20-gauge trocar system and technique. It utilizes the principles of the 23/25- gauge systems with trocars for instrument access and a separate infusion trocar. The trocars contain disposable valves, and thus, do not require plugs to maintain a closed system. They are inserted through tunneled wounds which can be left sutureless at the completion of surgery. Benefits of this array include the ability to utilize familiar vitreoretinal instruments and standard flow rates, decreased cost as compared to the smaller gauge systems, as well as the ability to undertake close peripheral vitreous shave.

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