The introduction of pars plana vitrectomy was a revolution in ophthalmic surgery which allowed successful treatment of many previously untreatable conditions. After rapid early technical development, 3-port 20-gauge vitrectomy became established as the norm. Recent years have seen the introduction of new and innovative systems for performing vitrectomy without the need for sutures. This article describes the history of sutureless vitrectomy, and reviews the literature addressing the advantages and disadvantages of each technique.

1.
Illiff CE: Treatment of the vitreous-tug syndrome. Am J Ophthalmol 1966;66:856–859.
2.
Kasner D: Vitrectomy: a new approach to management of vitreous. Highlights Ophthalmol 1969;11:304.
3.
Machemer R, Buettner H, Norton EWD, Parel JM: Vitrectomy: a pars plana approach. Trans Am Acad Ophthalmol Otolaryngol 1971;75:813.
4.
O’Malley C, Heintz RM: Vitrectomy with an alternative instrument system. Ann Ophthalmol 1975;7:585–594.
5.
Machemer R, Hickingbotham D: The three-port microcannular system for closed vitrectomy. Am J Ophthalmol 1985;100:590–592.
6.
Hilton GF: A sutureless self-retaining infusion cannula for pars plana vitrectomy. Am J Ophthalmol 1985;99:612.
7.
Mason G, Sullivan JM, Olk RJ: A sutureless self-retaining infusion cannula for pars plana vitrectomy. Am J Ophthalmol 1990;110:577–578.
8.
Chen JC: Sutureless pars plana vitrectomy through self-sealing sclerotomies. Arch Ophthalmol 1996;114:1273–1275.
9.
Milibak T, Suveges I: Complications of sutureless pars plana vitrectomy through self-sealing sclerotomies. Arch Ophthalmol 1998;116:119.
10.
Rahman R, Rosen PH, Riddell C, Towler H: Self-sealing sclerotomies for sutureless pars plana vitrectomy. Ophthalmic Surg Lasers 2000;31:462–466.
11.
Kwok AK, Tham CC, Lam DS, Li M, Chen JC: Modified sutureless sclerotomies in pars plana vitrectomy. Am J Ophthalmol 1999;127:731–733.
12.
Jackson T: Modified sutureless sclerotomies in pars plana vitrectomy. Am J Ophthalmol 2000;129:116–117.
13.
Assi AC, Scott RAH, Charteris DG: Reversed self-sealing pars plana sclerotomies. Retina 2000;20:689–692.
14.
Fujii GY, De Juan E, Humayun MS, et al: The new 25 gauge instrument system for transconjunctival sutureless vitrectomy surgery. Ophthalmol 2002;109:1807–1812.
15.
Fujii GY, De Juan E, Humayun MS, et al: Initial experience using the transconjunctival sutureless vitrectomy system for vitreoretinal surgery. Ophthalmol 2002;109:1814–1820.
16.
Ibarra MS, Hermel M, Prenner JL, Hassan TS: Longer-term outcomes of transconjunctival sutureless 25-gauge vitrectomy. Am J Ophthalmol 2005;139:831–836.
17.
Lakhanpal RR, Humayun MS, de Juan E Jr, et al: Outcomes of 140 consecutive cases of 25-gauge transconjunctival surgery for posterior segment disease. Ophthalmol 2005;112:817–824.
18.
Shimada H, Nakashizuka H, Mori R, Mizutani Y: Expanded indications for 25-gauge transconjunctival vitrectomy. Jpn J Ophthalmol 2005;49:397–401.
19.
Shah CP, Ho AC, Regillo CD, Fineman MS, Vander JF, Brown GC: Short-term outcomes of 25-gauge vitrectomy with silicone oil for repair of complicated retinal detachment. Retina 2008;28:723–728.
20.
Kellner L, Wimpissinger B, Stolba U, Brannath W, Binder S: 25 gauge versus 20 gauge system for pars plana vitrectomy: a prospective randomized clinical trial. Br J Ophthalmol 2007;91:945–948.
21.
Inoue M, Noda K, Ishida, S, Nagai N, Imamura Y, Oguchi Y: Intraoperative breakage of a 25-gauge vitreous cutter. Am J Ophthalmol 2004;138:867–869.
22.
Cohen SM, Flynn HW, Murray TG, Smiddy WE: Endophthalmitis after pars plana vitrectomy. The Postvitrectomy Endophthalmitis Study Group. Ophthalmol 1995;102:705–712.
23.
Eifrig CW, Scott IU, Flynn HW, et al: Endophthalmitis after pars plana vitrectomy: incidence, causative organisms, and visual acuity outcomes. Am J Ophthalmol 2004;138:799–802.
24.
Taylor SR, Aylward GW: Endophthalmitis following 25-gauge vitrectomy. Eye 2005;19:1228–1229.
25.
Kunimoto DY, Kaiser RS: Incidence of endophthalmitis after 20- and 25-gauge vitrectomy. Ophthalmol 2007;114:2133–2137.
26.
Martidis A, Chang TS: Sutureless 25-gauge vitrectomy: risky or rewarding? Ophthalmol 2007;114:2131–2132.
27.
Taban M, Ufret-Vincenty RL, Sears JE: Endophthalmitis after 25-gauge transconjunctival sutureless vitrectomy. Retina 2006;26:830–831.
28.
Scott IU, Flynn HW Jr, Dev S, et al: Endophthalmitis after 25-gauge and 20-gauge pars plana vitrectomy: incidence and outcomes. Retina 2008;28:138–142.
29.
Shimada H, Nakashizuka H, Hattori T, Mori R, Mizutani Y, Yuzawa M: Incidence of Endophthalmitis after 20- and 25-gauge vitrectomy. Ophthalmol 2008;115:2215–2220.
30.
Mason JO III, Yunker JJ, Vail RS, et al: Incidence of endophthalmitis following 20- gauge and 25-gauge vitrectomy. Retina 2008;28:1352–1354.
31.
Acar N, Unver YB, Altan T, Kapran Z: Acute endophthalmitis after 25-gauge sutureless vitrectomy. Int Ophthalmol 2007;27:361–363.
32.
Acar N, Kapran Z, Unver Y, Altan T Ozdogan S: Early postoperative hypotony after 25-gauge sutureless vitrectomy with straight incisions. Retina 2008;28:545–552.
33.
Lommatzsch A, Heimes B, Trieschmann M, Spital G, Pauleikhoff D: Long-term results after pars plana vitrectomy with 25 gauge technique. Ophthalmologe 2008;105:445–451.
34.
Rezende FA, Regis LGT, Kickinger M, Alcantara S: Decompression retinopathy after 25-gauge transconjunctival sutureless vitrectomy: report of 2 cases. Arch Ophthalmol 2007;125:699–700.
35.
Amato JE, Akduman L: Incidence of complications in 25-gauge transconjunctival sutureless vitrectomy based on the surgical indications. Ophthalmic Surg Lasers Imaging 2007;38:100–102.
36.
Cardascia N, Boscia F, Furino C, Sborgia L: Gentamicin-induced macular infarction in transconjunctival sutureless 25-gauge vitrectomy. Int Ophthalmol 2008;28:383–385.
37.
Lopez-Guajardo L, Vleming-Pinilla E, Pareja-Esteban J, Teus-Guezala MA: Ultrasound biomicroscopy study of direct and oblique 25-gauge vitrectomy sclerotomies. Am J Ophthalmol 2007;143:881–883.
38.
Riemann CD, Miller DM, Foster RE, Petersen MR: Outcomes of transconjunctival sutureless 25-gauge vitrectomy with silicone oil infusion. Retina 2007;27:296–303.
39.
Gupta OP, Weichel ED, Regillo CD, Fineman MS, Kaiser RS, Ho AC, McNamara JA, Vander JE: Postoperative complications associated with 25-gauge pars plana vitrectomy. Ophthalmic Surg Lasers Imaging 2007;38:270–275.
40.
Batman C, Ozdamar Y, Aslan O, Sonmez K, Mutevelli S, Zilelioglu G: Tissue glue in sutureless vitreoretinal surgery for the treatment of wound leakage. Ophthalmic Surg Lasers Imaging 2008;39:100–106.
41.
Lopez-Guajardo L, Pareja-Esteban J, Teus-Guezala M: Oblique sclerotomy technique for prevention of incompetent wound closure in transconjunctival 25-gauge vitrectomy. Am J Ophthalmol 2006;141:1154–1156.
42.
Hsu J, Chen E, Gupta O, Fineman MS, Garg SJ, Regillo CD: Hypotony after 25-gauge vitrectomy using oblique versus direct cannula insertions in fluid-filled eyes. Retina 2008;28:937–940.
43.
Shimada H, Nakashizuka H, Mori R, Mizutani Y, Hattori T: 25-gauge scleral tunnel transconjunctival vitrectomy. Am J Ophthalmol 2006;142:871–873.
44.
Singh RP, Bando H, Brasil OFM, Williams DR, Kaiser PK: Evaluation of wound closure using different incision techniques with 23-gauge and 25-gauge microincision vitrectomy systems. Retina 2008;28:242–248.
45.
Scartozzi R, Bessa AS, Gupta OP, Regillo CD: Intraoperative sclerotomy-related retinal breaks for macular surgery, 20- vs 25-gauge vitrectomy systems. Am J Ophthalmol 2007;143:155–156.
46.
Okuda T, Nishimura A, Kobayashi A, Sugiyama K: Postoperative retinal break after 25-gauge transconjunctival sutureless vitrectomy: report of four cases. Graefes Arch Clin Exp Ophthalmol 2007;245:155–157.
47.
Tan HS, Mura M, de Smet MD: Iatrogenic retinal breaks in 25-gauge macular surgery. Am J Ophthalmol 2009;148:427–430.
48.
Park SS, Marcus DM, Duker JS, et al: Posterior segment complications after vitrectomy for macular hole. Ophthalmology 1995;102:775–781.
49.
Byeon SH, Chu YK, Lee SC, Koh HJ, Kim SS, Kwon OW: Problems associated with the 25-gauge transconjunctival sutureless vitrectomy system during and after surgery. Ophthalmologica 2006;220:259–265.
50.
Rizzo S, Genovesi-Ebert F, Murri F, Belting C, Vento A, Cresti F, Manca ML: 25-gauge, sutureless vitrectomy and standard 20-gauge pars plana vitrectomy in idiopathic epiretinal membrane surgery: a comparative pilot study. Graefes Arch Clin Exp Ophthalmol 2006;244:472–479.
51.
Wickham L, Bunce CS, Kwan AS, Bainbridge JW, Aylward B: A pilot randomised controlled trial comparing the post-operative pain experience following vitrectomy with a 20-gauge system and the 25-gauge transconjunctival system. Br J Ophthalmol 2009, E-pub ahead of print.
52.
Jampel HD, Thompson JT, Nunez M, Michels RG: Corneal astigmatic changes after pars plana vitrectomy. Retina 1987;7:223–226.
53.
Eckert T, Eckardt C: Outcome of corneal astigmatism after pars plana vitrectomy with or without simultaneous cataract extraction. Ophthalmologe 1996;93:38–44.
54.
Wirbelauer C, Hoerauf H, Roider J, Laqua H: Corneal shape changes after pars plana vitrectomy. Graefes Arch for Clini Exp Ophthalmol 1998;236:822–828.
55.
Yanyali A, Celik E, Horozoglu F, Nohutcu AF: Corneal topographic changes after transconjunctival (25-gauge) sutureless vitrectomy. Am J Ophthalmol 2005;140:939–941.
56.
Kadonosono K, Yamakawa T, Uchio E, Yanagi Y, Tamaki Y, Araie M: Comparison of visual function after epiretinal membrane removal by 20-gauge and 25-gauge vitrectomy. Am J Ophthalmol 2006;142:513–515.
57.
Okamoto F, Okamoto C, Sakata N, Hiratsuka K, Yamane N, Hiraoka T, Kaji Y, Oshika T: Changes in corneal topography after 25-gauge transconjunctival sutureless vitrectomy versus after 20-gauge standard vitrectomy. Ophthalmol 2007;114:2138–2141.
58.
Citirik M, Batman C, Bicer T, Zilelioglu O: Keratometric alterations following the 25-gauge transconjunctival sutureless pars plana vitrectomy versus the conventional pars plana vitrectomy. Clin Exp Optometry 2009;92:416–420.
59.
Shinoda H, Nakajima T, Shinoda K, et al: Visual recovery after vitrectomy for macular hole using 25-gauge instruments. Acta Ophthalmol 2008;86:151–155.
60.
Guyomarch J, Delyfer MN, Korobelnik JF: Outcomes of 110 consecutive 25-gauge transconjunctival sutureless pars plana vitrectomies (in French). J Fr Opthalmol 2008;31:473–480.
61.
Heimann H: Primary 25- and 23-gauge vitrectomy in the treatment of rhegmatogenous retinal detachment – advancement of surgical technique or erroneous trend? Klin Monats Augen 2008;225:947–956.
62.
Lai MM, Runby AJ, Sarrafizadeh R, Urban KE, Hassan TS, Drenser KA, Garretson BR: Repair of primary rhegmatogenous retinal detachment using 25-gauge transconjunctival sutureless vitrectomy. Retina 2008;28:729–734.
63.
Acar N, Kapran Z, Altan T, Unver Y, Yurtsever S, Kucuksumer Y: Primary 25-gauge sutureless vitrectomy with oblique sclerotomies in pseudophakic retinal detachment. Retina 2008;28:1068–1074.
64.
Miller DM, Riemann CD, Foster RE, Petersen MR: Primary repair of retinal detachment with 25-gauge pars plana vitrectomy. Retina 2008;28:931–936.
65.
Eckardt C: Transconjunctival sutureless 23-gauge vitrectomy. Retina 2005;25:208–211.
66.
Hikichi T, Matsumoto N, Ohtsuka H, Higuchi M, Matsushita T, Ariga H, Kosaka S, Matsushita R: Comparison of one-year outcomes between 23- and 20-gauge vitrectomy for preretinal membrane. Am J Ophthalmol 2009;147:639–643.
67.
Fine HF, Iranmanesh R, Iturralde D, Spaide RF: Outcomes of 77 consecutive cases of 23-gauge transconjunctival vitrectomy surgery for posterior segment disease. Ophthalmol 2007;114:1197–1200.
68.
Parolini B, Romanelli F, Prigione G, Pertile G: Incidence of endophthalmitis in a large series of 23-gauge and 20-gauge transconjunctival pars plana vitrectomy. Graefes Arch Clin Exp Ophthalmol 2009:247:895–898.
69.
Lafeta, AP, Claes C: Twenty-gauge transconjunctival sutureless vitrectomy trocar system. Retina 2007;27:1136–1141.
70.
Kim JE, Shah SN, Choi DL, Han DP, Connor TB: Transconjunctival 20-gauge pars plana vitrectomy using a single entry cannulated sutureless system. Retina 2009;29:1294–1298.
71.
Gotzaridis EV: Sutureless transconjunctival 20 gauge pars plana vitrectomy. Semin Ophthalmol 2007;22:179–183.
72.
Zhao M, Zhou P, Xuan C, Wang Y, Li X: Manual small incision 20-gauge pars plana vitrectomy. Retina 2009;29:1364–1366.
73.
Lewis H: Sutureless microincision vitrectomy surgery: unclear benefit, uncertain safety. Am J Ophthalmol 2007;144:613–615.
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