Transconjunctival sutureless vitrectomy: initial experience and surgical tips

Abstract

We report the operative details and surgical outcomes of 39 consecutive transconjunctival sutureless vitrectomies using the TSV 25 system. We retrospectively reviewed the medical records of 35 patients (39 eyes) who underwent surgery using TSV 25 at the Department of Ophthalmology, Waterford Regional Hospital between March 2003 and February 2005. Preoperative, intraoperative and postoperative details were recorded and analysed. We also performed a systematic review of our surgical technique. Mean (+/-SD; range) duration of surgery was 32.85 (17.54; 5-85) min. Methods of anaesthesia included retrobulbar anaesthesia (31; 79.5%) and general anaesthesia (8; 20.5%). The mean (+/-SD; range) length of stay was 1.53 (1.25; 0-4) days. Mean (+/-SD; range) visual acuities (logMAR) were -1.335 (1.15; 0.0 to -3.0) and -0.803 (1.03; 0.1 to -3.0) preoperatively and postoperatively, respectively. The mean (+/-SD) intraocular pressures were 14.69 (4.64) mmHg and 11.56 (9.03) mmHg preoperatively and at the first dressing, respectively. Intraoperative complications included blockage of the TSV cutter tip during attempted clearance of organized intragel haemorrhage, thus requiring conversion to conventional trans pars plana vitrectomy (1; 2.6%). No other intraoperative complication arose. Complications in the postoperative period included: reactivation of dormant chorioretinal toxoplasmosis (1; 2.6%); postoperative posterior segment haemorrhage (3; 7.7%); hyphaema (1; 2.6%); transient postoperative hypotony (10; 25.6%). With appropriate case selection, and with appreciation of this technique's limitations, transconjunctival sutureless vitrectomy is a safe procedure.