A new approach for sutureless 20-G vitrectomy

Abstract

Aim of the work To assess the safety and the effectiveness of a new approach for sutureless 20-G pars plana vitrectomy using N -butyl-2-cyanoacrylate 'Histoacryl' glue, aiming for the conversion of the conventional 20-G vitrectomy to a sutureless technique. Design An interventional study. Patients and methods About 40 eyes of 40 patients attending the surgical retina clinics of the Research Institute of Ophthalmology were subjected to the new technique. The selection criterion included patients with diabetic and nondiabetic vitreous hemorrhage, rhegmatogenous retinal detachment (RD), recurrent RD, pseudophakic RD, giant retinal breaks, macular hole, proliferative diabetic retinopathy, complications of anterior segment surgery, posterior dislocated IOL, vitreomacular traction syndrome, macular pucker, idiopathic epiretinal membrane, and dropped nucleus. Patients were selected randomly. There was no age limitation, sex choice, or race preference. All the patients underwent a modified 20-G sutureless vitrectomy surgery. Periotomy was performed in the upper part of the eye, and the sclera was exposed, three 1/2-thickness scleral flaps were fashioned using a crescent knife for a length of 2 mm, and a 20-G self-retaining infusion cannula was introduced at the 12 O'clock position. At the end of the surgery, Histoacryl tissue glue was applied to close the scleral flaps and the conjunctiva. Different vitreal substitutes and tamponades were used according to the case. All the patients had undergone ultrasonic biomicroscopy at the sclerotomy sites 6 weeks postoperatively. Our main concern was to assess the success and the effectiveness of the procedure, wound integrity, intraoperative and postoperative complications, the efficacy of the N -butyl-2-cyanoacrylate to hold the tissues, tissue reaction related to cyanoacrylate, patients' satisfaction, and the final surgical outcome. The postoperative intraocular pressure (IOP) and the Snellen visual acuity relative to the preoperative values were recorded. Patients were evaluated postoperatively on the first day, the first week, and then weekly for 1 month and monthly for 6 months or till the time of removal of silicone oil, which was also removed by the same aforementioned technique. Results The proportion of male patients was 47.5% (19 patients) and that of female patients 52.5% (21 patients). The mean age of the male patients was 49 ΁ 12.5 years, whereas the mean age of the female patients was 44 ΁ 15.5 years. Different vitreous substitutes/tamponades were used, including air, SF6, ringer lactate, and silicon oil 5000 cSt. The mean operative time was 61.75 ΁ 13.8 min and the mean time fashioning and closing the sclerotomies and the conjunctiva was 7 ΁ 1.8 min. No sclerotomy-related intraoperative difficulties or complications were seen and none of the patients required stitching of the sclerotomies at the end of the surgery. All patients were discharged from the hospital immediately after the surgery. Ultrasonic biomicroscopy (UBM) revealed complete wound closure in 36 patients (90%), partial internal wound dehiscence in four patients (7.5%), and three patients (10%) showed microcyst formation under the conjunctiva. Postoperative hypotony was not seen in any of the patients.There was no single case of endophthalmitis or chemical uveitis. The visual acuity was improving along the follow-up period, except for one uncontrolled diabetic patient, who developed rubeosis iridis and the condition deteriorated. Most patients presented with an initial increase in the IOP followed by stabilization of the IOP thereafter. Conclusion The new approach of 20-G sutureless vitrectomy utilizing N -butyl-2-cyanoacrylate is a safe and effective technique for the surgical treatment of a variety of vitreoretinal pathologies. Conversion to this technique is very simple. A very short learning curve is required, with no need for new expensive instrumentation. It combines all the advantages of 20-G vitrectomy, adding to it the sutureless advantage of the technique.