Journal List > J Korean Ophthalmol Soc > v.51(1) > 1008729

Kim and Lee: Initial Experience With 20-Gauge Transconjunctival Sutureless Vitrectomy Using Conventional Instruments

Abstract

Purpose

To describe a transconjunctival sutureless technique for pars plana vitrectomy using conventional 20-gauge instruments.

Methods

We performed transconjunctival sutureless pars plana vitrectomy (TSV) using conventional 20-gauge instruments in 36 eyes of 35 patients. We made 20-gauge transconjunctival beveled sclerotomies using microvitreoretinal (MVR) blades and used traditional 20-gauge instruments for the operations.

Results

Eighty-three (81.4%) of 102 sclerotomies self-sealed without the need for sutures. The sutureless rate was even higher in the last one-third of the patients: 32 (94.1%) of 34 sclerotomy sites were sutureless. No serious complications were observed in our series, including postoperative hypotony, wound leakage, or endophthalmitis.

Conclusions

The 20-gauge TSV technique is safe and can be utilized for almost all vitreoretinal diseases, without incurring additional cost for new instruments.

References

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Figure 1.
(A) A traditional 20-gauge MVR blade is bent at the middle of the shaft before the operation to facilitate a transconjunctival sclera tunnel incision. (B) Diathermy is applied on the conjunctiva 3.5 mm from the limbus using pressure, while the conjunctiva is displaced laterally with a cotton-tipped applicator to misalign the conjunctival and scleral openings. (C) Temporary thinning and adhesion of the conjunctiva to the sclera is achieved. Three plane incision can make scleral tunnel more stable (D), but 1 plane incision is also acceptable (E). Direction of the tunnel can be either away from the operator (F) or toward the operator (G). (H) A 6 mm infusion cannula and endoilluminator, both of which are used in conventional 20-gauge pars plana vitrectomy, are placed after phacoemulsification has been performed. (I) Appearance at the end of the operation. Note self-sealing sclerotomies without leakage.
jkos-51-22f1.tif
Figure 2.
Postoperative visual acuity change. * Statistically significant values.
jkos-51-22f2.tif
Figure 3.
Postoperative astigmatism change. *Statistically significant values p-value by Mann-Whitney U test.
jkos-51-22f3.tif
Figure 4.
Changes in intraocular pressure over time.
jkos-51-22f4.tif
Figure 5.
(A) Severe conjunctival chemosis enough to interfere with preceding the operation occurred in two patients. By applying small incision on the conjunctiva and Tenon's capsule to drain the fluid (B), the remainder of the operation could be completed without difficulty (C).
jkos-51-22f5.tif
Figure 6.
Postoperative appearance at 1 day (A), 2 weeks (B), and 4 weeks (C) postoperatively.
jkos-51-22f6.tif
Table 1.
Surgical indications
Surgical Indications No. of Patients
Retinal detachment 7
Diabetic retinopathy 7
Vitreous hemorrhage due to other diseases 7
Idiopathic epiretinal membrane 6
Macular hole 1
Vitrectomized eye (for silicone oil removal) 8
Total 36
Table 2.
Sutureless rate showing a steep learning curve
A series of consecutive cases No. of sclerotomies
Sutureless rate p-value*
Sutured Sutureless Total
1st 12 Cases 14 20 34 58.8%
2nd 12 Cases 3 31 34 91.2% p<0.001
Last 12 Cases 2 32 34 94.1%
Total 19 83 102 81.4%

* p-value by Mantel Haenszel trend test.

Table 3.
Sutureless rate by location of sclerotomy sites
Sclerotomy location No. of sclerotomies
Sutureless rate p-value*
Sutured Sutureless Total
2 o'clock (usually used for an endoilluminator) 4 27 31 87.1%
10 o'clock (usually used for intraocular instruments) 6 29 35 82.9% 0.431
4 or 8 o'clock (used for an infusion cannula) 9 27 36 75.0%
Total 19 83 102 81.4%

* p-value by chi-square test.

Table 4.
Perioperative complications
Perioperative complications
Intraoperative chemosis 2
Severe subconjunctival hemorrhage 2
Choroidal detachment 1
Hypotony 0
Endophthalmitis 0
Wound Leakage 0
Recurrence of previous disease 0
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