J Korean Ophthalmol Soc.  2010 Jan;51(1):22-28.

Initial Experience With 20-Gauge Transconjunctival Sutureless Vitrectomy Using Conventional Instruments

• Kim KH
• Lee JE

Abstract

PURPOSE
To describe a transconjunctival sutureless technique for pars plana vitrectomy using conventional 20-gauge instruments.
METHODS
We performed transconjunctival sutureless pars plana vitrectomy (TSV) using conventional 20-gauge instruments in 36 eyes of 35 patients. We made 20-gauge transconjunctival beveled sclerotomies using microvitreoretinal (MVR) blades and used traditional 20-gauge instruments for the operations.
RESULTS
Eighty-three (81.4%) of 102 sclerotomies self-sealed without the need for sutures. The sutureless rate was even higher in the last one-third of the patients: 32 (94.1%) of 34 sclerotomy sites were sutureless. No serious complications were observed in our series, including postoperative hypotony, wound leakage, or endophthalmitis.
CONCLUSIONS
The 20-gauge TSV technique is safe and can be utilized for almost all vitreoretinal diseases, without incurring additional cost for new instruments.

Keyword

Self-sealing sclerotomies; Sutureless vitrectomy; Transconjunctival; TSV; 20-gauge pars plana vitrectomy

MeSH Terms

Eye
Humans
Sutures
Vitrectomy

Figure

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  Figure 1. (A) A traditional 20-gauge MVR blade is bent at the middle of the shaft before the operation to facilitate a transconjunctival sclera tunnel incision. (B) Diathermy is applied on the conjunctiva 3.5 mm from the limbus using pressure, while the conjunctiva is displaced laterally with a cotton-tipped applicator to misalign the conjunctival and scleral openings. (C) Temporary thinning and adhesion of the conjunctiva to the sclera is achieved. Three plane incision can make scleral tunnel more stable (D), but 1 plane incision is also acceptable (E). Direction of the tunnel can be either away from the operator (F) or toward the operator (G). (H) A 6 mm infusion cannula and endoilluminator, both of which are used in conventional 20-gauge pars plana vitrectomy, are placed after phacoemulsification has been performed. (I) Appearance at the end of the operation. Note self-sealing sclerotomies without leakage.

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  Figure 2. Postoperative visual acuity change. * Statistically significant values.

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  Figure 3. Postoperative astigmatism change. *Statistically significant values †p-value by Mann-Whitney U test.

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  Figure 4. Changes in intraocular pressure over time.

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  Figure 5. (A) Severe conjunctival chemosis enough to interfere with preceding the operation occurred in two patients. By applying small incision on the conjunctiva and Tenon's capsule to drain the fluid (B), the remainder of the operation could be completed without difficulty (C).

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  Figure 6. Postoperative appearance at 1 day (A), 2 weeks (B), and 4 weeks (C) postoperatively.

Reference

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