Transconjunctival sutureless vitrectomy versus 20-gauge vitrectomy for vitreoretinal surgery: a meta-analysis of randomized controlled trials

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Transconjunctival sutureless vitrectomy is appealing to vitreoretinal surgeons around the world. However, its use versus 20-gauge vitreoretinal surgery is still controversial. The aim of this meta-analysis was to compare the safety and functional outcomes of transconjunctival sutureless vitrectomy versus 20-gauge vitrectomy for vitreoretinal surgery. Data sources, including PubMed, Medline, EMBASE, and Cochrane Controlled Trials Register, were searched to identify potentially relevant randomized controlled trials. A meta-analysis was performed using RevMan 5.0 software. The primary factors included patients' discomfort, operating time and early postoperative complications. Visual acuity and surgically induced astigmatism were chosen as secondary outcomes. A total of 471 participants with 479 eyes in eight trials between 2005 and 2011 were analyzed. Transconjunctival sutureless vitrectomy was associated with significantly fewer patients suffering from postoperative discomfort at 1 day (odds ratio [OR] 0.07; 95 % confidence interval [CI] 0.01 to 0.49; p = 0.007) and 7 days (OR 0.14; 95 % CI 0.03 to 0.73; p = 0.02) follow-up, and was more effective in reducing surgically induced astigmatism (mean difference -0.23D; 95 % CI -0.31 to -0.15; p < 0.00001) compared to 20-gauge vitrectomy. The sutureless group achieved shorter wound opening (mean difference -1.97 minutes; 95 % CI -2.69 to -1.25; p < 0.00001) as well as wound closure time (mean difference -4.55 minutes; 95 % CI -5.43 to -3.66; p < 0.00001), but the overall surgery time was comparable (mean difference -0.14 minutes; 95 % CI -3.52 to 3.24; p = 0.93). There were no significant differences in the complication rates between the two groups with the exception of postoperative hypotony, which was more likely with the sutureless group (OR 3.73; 95 % CI 1.43 to 9.76; p = 0.007). According to the present data, transconjunctival sutureless vitrectomy offered significantly less postoperative discomfort and decreased surgically induced astigmatism without increasing the risk of vision-threatening complications. Further trials with contemporary equipment and larger sample size are suggested to confirm this conclusion.