The safety and efficacy of transconjunctival sutureless 23-gauge vitrectomy

Abstract

Purpose: To evaluate the efficacy and safety of vitreoretinal surgery using a 23-gauge transconjunctival sutureless vitrectomy (TSV) system for various vitreoretinal diseases.

Methods: A retrospective, consecutive, interventional case series was performed for 40 eyes of 40 patients. The patients underwent vitreoretinal procedures using the 23-gauge TSV system, including idiopathic epiretinal membrane (n=7), vitreous hemorrhage (n=11), diabetic macular edema (n=10), macular hole (n=5), vitreomacular traction syndrome (n=5), diabetic tractional retinal detachment (n=1), and rhegmatogenous retinal detachment (n=1). Best corrected visual acuity (BCVA), intraocular pressure (IOP), and intra- and post-operative complications were evaluated.

Results: Intraoperative suture placement was necessary in 3 eyes (7.5%). The median BCVA improved from 20/400 (LogMAR, 1.21+/-0.63) to 20/140 (LogMAR, 0.83+/-0.48) at 1 week (p=0.003), 20/100 (LogMAR, 0.85+/-0.65) at 1 month (p=0.002), 20/100 (LogMAR, 0.73+/-0.6) at 3 months (p=0.001). In 1 eye, IOP was 5 mmHg at 2 hours and 4 mmHg at 5 hours, but none of the eyes showed hypotony after 1 postoperative day. No serous postoperative complications were observed during a mean follow-up of 8.4+/-3.4 months (range 3-13 months)

Conclusions: The 23-gauge TSV system shows promise as an effective and safe technique for a variety of vitreoretinal procedures. It appears to be a less traumatic, more convenient alternative to 20-gauge vitrectomy in some indications.

Fig. 1

Anterior segment photography of eyes after performing 20-gauge standard vitrectomy (A: postoperative 1 week, C: postoperative 6 weeks) and 23-gauge transconjunctival sutureless vitrectomy (B: postoperative 1 week, D: postoperative 6 weeks). Conjunctival injection and late scar formation were almost negligible in the external feature of the eyes that underwent 23-gauge TSV (B,D). On the contrary, severe conjunctival injection (A) and late protruding healed scar were prominent in the eye that underwent 20-gauge vitrectomy (A,C).

Fig. 2

Preoperative and postoperative intraocular pressure changes at 2 hours, 5 hours, 1 day, 1 week, and 1 month. There were no significant differences in IOP among the measurements. No hypotony was observed after 1 postoperative day in any of the 40 eyes. preop=preoperative; h=hours; d=day; w=week; m=month.

Fig. 3

Visual acuity in logarithm of the minimal angle of resolution (LogMAR) units observed preoperatively and postoperatively at 1 week and 1, 3 and 6 months following surgery. Visual improvement was noted at 1 week and 1, 3 and 6 months following 23-gauge transconjunctival sutureless vitrectomy (Wilcoxon signed rank test, P < .05). Preop; preoperative, wk; week, mo; month.

Fig. 4

Comparison among the infusion rates of balanced saline solution for 20-, 23- and 25-gauge infusion cannulas. The overall average infusion rate of the 23-gauge cannula was 1.7- and 2.8-fold greater than that of the 20- and 25-gauge cannulas, respectively.

Fig. 5

Comparison among the aspiration rates of balanced saline solution for 20-, 23- and 25-gauge ocutomes. The overall average aspiration rate of the 20-gauge ocutome was 3.2- and 5.9-fold greater than that of the 23- and 25-gauge ocutomes, respectively. The average aspiration rate of the 23-gauge ocutome was 1.9-fold greater than that of the 25-gauge ocutome.