Transconjunctival Sutureless Vitrectomy
Technology Spotlight

Standard pars plana vitrectomy uses 20 gauge incisions made by a knive to introduce instruments into the eye.  The 20 gauge incisions are about 1.2 mm long (1/20th inch) and need to be sutured closed at the end of the surgery.  Most surgeons use a resorbable suture.

A new 25 gauge vitrectomy system has been in use in our practice for since 2005 allowing some surgeries to be performed using small incisions and smaller instruments.

In this technique, the scleral incisions are made through the conjunctiva and are small enough to be self-sealing. This allows the vitrectomy instruments to be used without creating an initial peritomy to expose bare sclera, and the technique also obviates the need for sutures at the end of the case. Data from several small clinical trials show positive results, and the technique may gain wide acceptance by many retina surgeons over the coming years.

Transconjunctival sutureless vitrectomy has been used effectively for treatment of several diseases including removal of epiretinal membranes, repair of macular holes and retinal detachments, sheathotomy for branch retinal vein occlusions, treatment of retinopathy of prematurity, and removal of vitreous hemorrhage or retained lens material. Indeed, most vitreoretinal procedures that do not require extensive intraocular tissue dissection could potentially be candidates for transconjunctival sutureless vitrectomy. An important potential benefit of this technique is its use in pediatric vitreoretinal surgery. In newborns and infants requiring vitrectomy, use of small ports could be especially important since these patients have relatively small eyes that require more delicate, flexible instruments. The technique can also be used during cataract surgery when the posterior capsule is ruptured and there is vitreous to the wound. In this scenario, the corneal wound is sutured to create a closed system, an infusion cannula is inserted through the side port, and a transconjunctival incision is made at the pars plana, through which a 25 gauge vitreous cutter is inserted and used to perform an anterior vitrectomy.

The technique does have its drawbacks. For example, it may be necessary to place a suture for those cases that require a very complete peripheral vitrectomy. This is because some vitreous is required to plug the sclerostomies, and its absence may lead to post-operative wound leak. In addition, mastering the use of the delicate and more flexible instruments does require a certain learning curve, even by experienced vitreoretinal surgeons. However, given that transconjunctival sutureless vitrectomy creates wounds that are 50% smaller in diameter and up to 75% smaller in cross-sectional area, the technique appears to be a highly important innovation that is here to stay.