Journal List > J Korean Ophthalmol Soc > v.49(1) > 1008243

Jin, Choi, Kim, and Kim: A Combination of 23-gauge and 20-gauge Transconjunctival Sutureless Vitrectomy

Abstract

Purpose

To describe the clinical experience and safety profile of a combination of 23-gauge and 20-gauge transconjunctival sutureless vitrectomy (TSV)

Methods

Thirty-seven eyes of thirty-seven consecutive patients who underwent 23-gauge combined with 20-gauge transconjunctival vitrectomy surgery by a single surgeon from August 2006 through December 2006 were reviewed retrospectively for surgical indications, wound problems, and postoperative complications.

Results

Thirty-seven eyes, including eyes with proliferative diabetic retinopathy (n=24), macular hole (n=3), epiretinal membrane (n=3), vitreous hemorrhage due to branch retinal vein occlusion and choroidal neovascular membrane (n=3), vitreous opacity secondary to uveitis (n=1), rhegmatogenous retinal detachment (n=1), and vitreoretinal traction syndrome (n=1), underwent operation. Seven eyes at 23-gauge sclerotomy sites and 15 eyes at 20-gauge sclerotomy sites had subconjunctival hemorrhage. Three eyes required sutures at 20-gauge sclerotomy sites intraoperatively due to wound leakage. One wound hemorrhage occurred at a 23-guage sclerotomy site. Vitreous hemorrhage (4 eyes), hyphema (2 eyes), and vitreous hemorrhage with hyphema (1 eye) occurred postoperatively. Postoperative hypotony, retinal detachment, and other complications did not occur.

Conclusions

A combination of 23-gauge and 20-gauge transconjunctival sutureless vitrectomy which was created by modifying transconjunctival sutureless vitrectomy systems published previously guarded against sclerotomy wounds and a variety of vitreoretinal surgical indications.

References

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Figure 1.
(A) Standard position of two 23-guage microcannulas and 20-guage self-sealing sclerotomy in the left eye (surgeon’s view). Note the tunnel-shaped opening of cannulas and a special pressure plate for easy insertion of the vitreoretinal instruments.(B) Pressure plate which is sutured at 20-gauge self-sealing sclerotomy to prevent operative chemosis. The size of internal opening was 2 mm×1.5 mm for movement of 20-gauge instruments. 4 notches were suture sites for fixation of plate on the conjunctiva and sclera
jkos-49-65f1.tif
Table 1.
Patients’ characteristics in study
Patients (eyes) N=37
Sex
 Male 19
 Female 18
Age (years)
 Mean±SD 57±7.4
Bilaterality (eyes)
 OD 16
 OS 21
Lens state (eyes)
 Phakic 23
 Pseudophakic 14
 Aphakic 0
Intraocular pressure (mmHg)
 Preoperative day (Mean±SD) 14±3.2
Diagnosis for vitrectomy (eyes)
 Proliferative diabetic retinopathy 24
 Vitreous hemorrhage due to BRVO*, CNV 3
 Vitreous opacity due to uveitis 1
 Macular hole 3
 Epiretinal membrane 3
 Rhegmatogenous retinal detachment 1
 Vitreomacular traction syndrome 1
 Lens dislocation 1

* BRVO=Branch retinal vein occlusion.

CNV=Choroidal neovascularization.

Table 2.
Wound complications at sclerotomy sites
No. of Patients with Complications n=37eyes (%) No. of Sclerotomy with Complications
23 gauge sclerotomy n=74sites (%) 20 gauge sclerotomy n=37sites (%)
Subconjuctival hemorrhage 17 (45.9) 11 (14.9) 15 (40.5)
Wound leaking 3 (8.1) 0 3 (8.1)
Wound extension / dehiscence 0 0 0
Wound hemorrhage 1 (2.7) 1(1.4) 0
Vitreous incarceration 0 0 0
Retinal incarceration 0 0 0
Retinal tears 0 0 0
Retinal dialysis 0 0 0
Table 3.
Complications in 23G* combined 20G* TSV
Complications Eyes Rate (%)
Hypotony 0 0
Vitreous hemorrhage 4 11
Hyphema 2 5
Vitreous hemorrhage and hyphema 1 3
Retinal detachment 0 0

* G=gauge.

TSV=transconjunctival sutureless vitrectomy.

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