A Combination of 23-gauge and 20-gauge Transconjunctival Sutureless Vitrectomy

Sun Young Jin; Moon Jeong Choi; Chul Gu Kim; Jong Woo Kim

doi:10.3341/jkos.2008.49.1.65

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

Original Article

J Korean Ophthalmol Soc 2008;49(1):65-70.

Published online: 3 August 2008

DOI: https://doi.org/10.3341/jkos.2008.49.1.65

A Combination of 23-gauge and 20-gauge Transconjunctival Sutureless Vitrectomy

Sun Young Jin, M.D.¹, Moon Jeong Choi, M.D.², Chul Gu Kim, M.D.¹, Jong Woo Kim, Ph.D.¹

¹Department of Ophthalmology, Colleage of Medicine, Konyang University, Daejeon, Korea

²Myung Gok Eye Research Institute, Kim’s Eye Hospital, Konyang University, Seoul, Korea

Address reprint requests to Chul Gu Kim, M.D. Department of Opthalmology, Colleage of Medicine, Konyang University #685, Gasuwon-dong, Seo-gu, Daejeon 302-241, Korea Tel: 82-42-600-9258, Fax: 82-42-600-9176, E-mail: chulgukim@hanmail.net

Received 16 March 2007 Accepted 4 September 2007

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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.

Keywords: Self-sealing sclerotomy, Transconjunctival sutureless vitrectomy

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

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
	No. of Patients with Complications n=37eyes (%)	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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