Abstract
Objective:To compare effectiveness of releasable transconjunctival sutures in 23 gauge vitrectomy and standard 20 gauge vitrectomy.Methods:This prospective comparative study was conducted in Department of Vitreoretinal Surgery, Al Ehsan Eye Hospital, Lahore from June 2016 to March 2017. It included 84 patients in total (Group-A: 42 patients underwent 23 gauge releasable suture vitrectomy; Group-B: 42 patients who underwent standard 20 gauge vitrectomy). Pre operative and post operative best corrected visual acuity, surgical duration, pre and post operative intraocular pressure and complication profile was compared between two groups.Results:The leading cause for vitrectomy was vitreous haemorrhage. (Group-A; n=15 ;35.71%; Group-B; n=17; 40.47%). There was statistically significant improvement in preoperative and postoperative BCVA in both groups (Group A: P-value < 0.05; Group B P-value < 0.05) but there was no significant difference in post operative BCVA between two groups at 3 months (P-value > 0.05). Surgical time for 23G vitrectomy Group was statistically less than 20 G vitrectomy Group (51 +/-18 minutes for Group-A versus 78 +/- 13 minutes for Group-B; p-value < 0.05). Visual analog score for pain / discomfort was also significantly less for Group-A than Group-B. There was no significant difference in intraocular pressures between the two groups.Conclusions:Releasable suture technique for small gauge vitrectomy is a safe and easily adaptable technique that has certain significant advantages over 20G absorbable suture vitrectomy.
Highlights
The introduction of small gauge vitrectomy has given vitreoretinal surgeons an alternative of a less invasive surgical option when compared to traditional 20 gauge (20G) pars plana vitrectomy.[1]
The main advantage of this technique is that removal of sutures is easy and pain free, avoid suture related complications and prevent post operative hypotony which may be associated with suture less vitrectomy
The other Group underwent standard 20G vitrectomy where all 3 ports were secured with 7 0 vicryl suture at the end of surgery
Summary
The introduction of small gauge vitrectomy has given vitreoretinal surgeons an alternative of a less invasive surgical option when compared to traditional 20 gauge (20G) pars plana vitrectomy.[1] Earliest small gauge vitrectomy systems utilized 23 gauge (23G) trocars, cannulas and instruments and was first introduced by Claus Eckhardt.[2] 23G vitrectomy is considered standard option for most advanced retinal surgeries.[2] The main aim of smaller gauge vitrectomy systems is to reduce operative and recovery times, able to perform more delicate and intricate manoeuvres during surgery and avoid the complications known with larger gauge instruments This quest has led to introduction of further small gauge instruments like. This has been possible because of innovations like more powerful light sources, rigid materials for small gauge instruments and more efficient vitrectomy machines with better fluidics and controls.[3,4]
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