Revisiting transconjunctival sutureless 25‐gauge vitrectomy: still worthwhile?

Abstract

To present the outcomes of various retinal conditions treated with the sutureless 25-gauge (25G) vitrectomy technique. Retrospective case review of 232 eyes of 228 patients who underwent 25G vitrectomy from January 2003 to August 2006. Follow-up was a minimum of 3 months. Indications for surgery included idiopathic macular hole, rhegmatogenous retinal detachment, epiretinal membrane and proliferative diabetic retinopathy. Main outcome measures included final visual acuity, re-operation rate and surgical complications such as endophthalmitis, hypotony and retinal (re)detachment. For all cases, the mean overall visual acuity (logMAR) improved from 0.9 preoperatively to 0.5 (P < 0.0001). The improvement in acuity was highest in the rhegmatogenous detachment and diabetic groups. Transient postoperative hypotony was observed in 15 cases (9.2%) on day 1 after surgery but all these cases resolved. In 7.3% of the cases (17 out of 232) additional surgery was performed due to retina (re)detachment but final anatomic success was achieved in all cases; the detachments occurred within the first 3 months. One patients developed endophthalmitis (0.4%) which coincided with subconjunctival antibiotics being discontinued in favour of topical treatment. The 25G system remains a safe and effective technique for a variety of retinal conditions; significant fast visual rehabilitation is an advantage.

Study of Intraocular Pressure After 23-Gauge and 25-Gauge Pars Plana Vitrectomy Randomized to Fluid Versus Air Fill

“…24,42,43,[48][49][50][51] Postoperative hypotony at any point within the first week in this series after 25-gauge PPV was seen in 5 of 54 patients (9.3%), which is consistent with the published rates of hypotony after 25-gauge PPV that range from 0% to 9.2%. 21,52,53 The overall rate of hypotony at any point in the first postoperative week in our series regardless of size of instrumentation was 9.8% (9 of 92 patients). When looking at postoperative hypotony, only 7 of 92 patients (7.6%) had this complication 2 hours postoperatively, which is slightly lower than the rate of 11.3% cited by another study.…”

Macular vascular circulation and retinal oxygen saturation changes for idiopathic macular epiretinal membrane after vitrectomy

“…Vitrectomy combined with membrane‐peeling surgery is an effective method to manage macular membranes (Sandinha et al. ; Wei et al. ; Kim et al.…”

Outcomes of 25-gauge vitrectomy for proliferative diabetic retinopathy

“…Fujii et al [1,2] described the use of a 25-gauge transconjunctival sutureless vitrectomy (25-G TSV) system, and found it applicable to a variety of vitreoretinal pathologies. Since that time, many investigators have reported successful results with 25-G TSV, its popularity has been rapidly increasing, and its indications continue to expand [2][3][4][5][6][7].…”

“…The sutureless nature of small-gauge vitrectomy leads to less traumatic surgical manipulation, less surgically induced astigmatism, and less postoperative patient discomfort, which facilitates early visual recovery [2][3][4][5][6][7][8]. However, this technique has been associated with a higher incidence of complications such as postoperative hypotony, choroidal detachment and endophthalmitis [9][10][11][12][13].…”