25-Gauge Transconjunctival Sutureless Pars Plana Vitrectomy

Abstract

To evaluate the effectiveness, feasibility, and safety of the transconjunctival sutureless vitrectomy (TSV) system for a vriety of vitreoretinal diseases. In this retrospective study, the authors evaluated 71 eyes of 63 patients who underwent pars plana vitrectomy (PPV) with the 25-gauge TSV system. The indications for surgical intervention were diabetic vitreous hemorrhage (29 eyes), diabetic macular edema (14 eyes), macular epiretinal membrane (13 eyes), endophthalmitis (5 eyes), vitreous opacities secondary to Behcet's disease (4 eyes), vitreous hemorrhage secondary to branch retinal vein occlusion (4 eyes), and vitreous hemorrhage secondary to age-related macular degeneration (2 eyes). Epiretinal membrane and internal limiting membrane removal, endolaser photocoagulation, and air-fluid exchange were performed when required. Mean follow-up was 3.6 months (range 1-8 months). Mean overall visual acuity (VA) was counting fingers (range light perception to 0.4) preoperatively and 0.2 (range 0.1 to 0.8) postoperatively (p=0.000). Statistically significant VA improvement was observed in eyes with vitreous hemorrhage, diabetic macular edema, and macular epiretinal membrane. VA improved postoperatively in all eyes with endophthalmitis and vitreous opacities secondary to Behcet's disease. The surgery was completed without conjunctival and scleral suturing in all eyes. Mean intraocular pressure (IOP) was 17.2 mmHg (range 10-26 mmHg) preoperatively, 12.4 mmHg (range 6-24 mmHg) on the first postoperative day, 16.6 mmHg (range 10-33 mmHg) at 1 week, and 15.4 mmHg (range 10-20 mmHg) at 1 month postoperatively. On the first postoperative day, IOP was below 10 mmHg (between 6 and 9 mmHg) in 12 eyes (16.9%). In these eyes, IOP was normalized within 1 week without affecting the visual outcome. Five eyes (7%) had transient increase of IOP controlled by topical antiglaucomatous medications. Vitreous washout using 25-gauge TSV system was performed in two eyes, in which vitreous hemorrhage recurred. The TSV system was observed to be feasible, effective, and safe for a variety of vitre o retinal diseases. This minimally invasive and completely sutureless (transconjunctival) technique appears to decrease the convalescence period, operating time, and postoperative inflammatory response, and improve patient comfort.