Purpose: To study the safety of 20-gauge transconjunctival sutureless vitrectomy. Methods: Clinical data of patients who underwent 20-gauge transconjunctival sutureless vitrectomy for the first time, for various disorders, were reviewed retrospectively. The main outcome measures were the number of sclerotomies requiring suturing as well as the intra- and postoperative complications. Results: A total of 179 operations were performed. Indications for vitrectomy included 68 idiopathic epiretinal membranes, 26 macular holes, 23 phakic and 16 pseudophakic retinal detachments, and 46 various other, less common etiologies. Of these 179 operations, 166 (93%) were sutureless. Of the 537 sclerotomies created, 25 (5%) received a single transconjunctival-scleral suture. Intraoperative complications included premature dislodging of the cannulas in 2 sclerotomies and an iatrogenic horseshoe tear at 1 sclerotomy site. Postoperative complications comprised transient hypotony in 14 cases, subconjunctival gas in 2 cases, and choroidal effusion in 1 case. No serious complications (such as endophthalmitis) were observed. Conclusion: 20-gauge transconjunctival sutureless vitrectomy can be considered safe, as the intra- and postoperative complications observed are neither numerous nor significant. Sclerotomies appear to be safe and relatively easy to perform, without compromising the advantages of sutureless surgery.

Keywords:
20-gauge transconjunctival sutureless vitrectomy, Safety, Sclerotomies
1.
Kraff MC, Sanders DR: Planned extracapsular extraction versus phacoemulsification with IOL implantation: a comparison of concurrent series. J Am Intraocul Implant Soc 1982;8:38-41.
2.
Cleasby GW: The advantages and disadvantages of Kelman phacoemulsification (KPE). Ophthalmology 1979;86:1973-1979.
3.
Kaiya T: Observation of blood-aqueous barrier function after posterior chamber intraocular lens implantation. J Cataract Refract Surg 1990;16:320-324.
4.
Oshika T, Yoshimura K, Miyata N: Postsurgical inflammation after phacoemulsification and extracapsular extraction with soft or conventional intraocular lens implantation. J Cataract Refract Surg 1992;18:356-361.
5.
Sanders DR, Spigelman A, Kraff C, Lagouros P, Goldstick B, Peyman GA: Quantitative assessment of postsurgical breakdown of the blood-aqueous barrier. Arch Ophthalmol 1983;101:131-133.
6.
Peyman GA: A pneumovitrector for the diagnostic biopsy of the vitreous. Ophthalmic Surg Lasers 1996;27:246-247.
7.
Fujii GY, De Juan E Jr, Humayun MS, Pieramici DJ, Chang TS, Awh C, Ng E, Barnes A, Wu SL, Sommerville DN: A new 25-gauge instrument system for transconjunctival sutureless vitrectomy surgery. Ophthalmology 2002;109:1807-1812.
8.
Peyman GA: A miniaturized vitrectomy system for vitreous and retinal biopsy. Can J Ophthalmol 1990;25:285-286.
9.
Fujii GY, De Juan E Jr, Humayun MS, Chang TS, Pieramici DJ, Barnes A, Kent D: Initial experience using the transconjunctival sutureless vitrectomy system for vitreoretinal surgery. Ophthalmology 2002;109:1814-1820.
10.
Inoue M, Noda K, Ishida S, Nagai N, Imamura Y, Oguchi Y: Intra-operative breakage of 25-gauge vitreous cutter. Am J Ophthalmol 2004;138:867-869.
11.
Eckardt C: Transconjunctival sutureless 23-gauge vitrectomy. Retina 2005;25:208-211.
12.
Shimada H, Nakashizuka H, Nakajima M, Mori R, Mizutani Y: Twenty-gauge transconjunctival vitrectomy. Jpn J Ophthalmol 2005;49:257-260.
13.
Gotzaridis EV: Three-port 20-gauge transconjunctival pars plana vitrectomy. Retina 2007;27:382-384.
14.
Gotzaridis EV: Sutureless transconjunctival 20 gauge pars plana vitrectomy. Semin Ophthalmol 2007;22:179-183.
15.
Lafetá AP, Claes C: Twenty-gauge transconjunctival sutureless vitrectomy trocar system. Retina 2007;27:1136-1141.
16.
Haas A, Seidel G, Steinbrugger I, Maier R, Gasser-Steiner V, Wedrich A, Weger M: Twenty-three-gauge and 20-gauge vitrectomy in epiretinal membrane surgery. Retina 2010;30:112-116.
17.
Kellner L, Wimpissinger B, Stolba U, Brannath W, Binder S: 25-gauge vs 20-gauge system for pars plana vitrectomy: a prospective randomised clinical trial. Br J Ophthalmol 2007;91:945-948.
18.
Misra A, Ho-Yen G, Burton RL: 23-gauge sutureless vitrectomy and 20-gauge vitrectomy: a case series comparison. Eye (Lond) 2009;23:1187-1191.
19.
Rizzo S, Genovesi-Ebert F, Murri S, 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.
20.
Romero P, Salvat M, Almena M, Baget M, Méndez I: Étude comparative de la vitrectomie transconjonctivale sans suture à 25- gauges avec celle à 20-gauges: à propos de 132 interventions. J Fr Ophtalmol 2006;29:1025-1032.
21.
Romero-Aroca P, Almena-Garcia M, Baget-Bernaldiz M, Fernández-Ballart J, Méndez-Marin I, Bautista-Perez A: Differences between the combination of the 25-gauge vitrectomy with phacoemulsification versus 20-gauge vitrectomy and phacofragmentation. Clin Ophthalmol 2009;3:671-679.
22.
Yang SJ, Yoon SY, Kim JG, Yoon YH: Transconjunctival sutureless vitrectomy for the treatment of vitreoretinal complications in patients with diabetes mellitus. Ophthalmic Surg Lasers Imaging 2009;40:461-466.
23.
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.
24.
Inoue Y, Kadonosono K, Yamakawa T, Uchio E, Watanabe Y, Yanagi Y, Tamaki Y, Araie M: Surgically induced inflammation with 20-, 23-, and 25-gauge vitrectomy systems: an experimental study. Retina 2009;29:477-480.
25.
Mentens R, Stalmans P: Comparison of postoperative comfort in 20 gauge versus 23 gauge pars plana vitrectomy. Bull Soc Belge Ophtalmol 2009;311:5-10.
26.
Wickham L, Bunce C, Kwan AS, Bainbridge J, Aylward GW: 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 2010;94:36-40.
27.
Wimpissinger B, Kellner L, Brannath W, Krepler K, Stolba U, Mihalics C, Binder S: 23-gauge versus 20-gauge system for pars plana vitrectomy: a prospective randomised clinical trial. Br J Ophthalmol 2008;92:1483-1487.
28.
Avitabile T, Castiglione F, Bonfiglio V, Castiglione F: Transconjunctival sutureless 25- gauge versus 20-gauge standard vitrectomy: correlation between corneal topography and ultrasound biomicroscopy measurements of sclerotomy sites. Cornea 2010;29:19-25.
29.
Galway G, Drury B, Cronin BG, Bourke RD: A comparison of induced astigmatism in 20- vs 25-gauge vitrectomy procedures. Eye (Lond) 2010;24:315-317.
30.
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. Ophthalmology 2007;114:2138-2141.
31.
Yanyali A, Celik E, Horozoglu F, Nohutku AF: Corneal topographic changes after transconjunctival (25-gauge) sutureless vitrectomy. Am J Ophthalmol 2005;140:939-941.
32.
Park DH, Shin JP, Kim SY: Surgically induced astigmatism in combined phacoemulsification and vitrectomy; 23-gauge transconjunctival sutureless vitrectomy versus 20-gauge standard vitrectomy. Graefes Arch Clin Exp Ophthalmol 2009;247:1331-1337.
33.
Lee JE, Kim KH, Kim IK, Jea SY, Kim WS: Comparison of 20-gauge transconjunctival sutureless vitrectomy with conventional vitrectomy. Retina 2010;30:1496-1504.
34.
Mohamed AA, Abdrabbo M: Corneal topographic changes following trans-conjunctival 20 gauge sutureless vitrectomy (TC20V). Clin Ophthalmol 2012;6:565-569.
35.
Spierer O, Siminovsky Z, Loewenstein A, Barak A: Outcomes of 20-gauge transconjunctival sutureless vitrectomy. Retina 2011;31:1765-1771.
36.
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.
37.
Dassie-Ajdid J, Mahieu L, Mathis V, Arné JL, Auriol S: Évaluation de la vitrectomie transconjonctivale 20-gauge sans suture. J Fr Ophtalmol 2011;34:729-736.
38.
Chen D, Lian Y, Cui L, Lu F, Ke Z, Song Z: Sutureless vitrectomy incision architecture in the immediate postoperative period evaluated in vivo using optical coherence tomography. Ophthalmology 2010;117:2003-2009.
39.
Fine HF, Iranmanesh R, Iturralde D, Spaide RF: Outcomes of 77 consecutive cases of 23-gauge transconjunctival vitrectomy surgery for posterior segment disease. Ophthalmology 2007;114:1197-1200.
40.
Taban M, Ventura AA, Sharma S, Kaiser PK: Dynamic evaluation of sutureless vitrectomy wounds: an optical coherence tomography and histopathology study. Ophthalmology 2008;115:2221-2228.
41.
Mangioris G, Mendrinos E, Papadopoulou DN, Pournaras CJ: Optical coherence tomography of wound architecture of 20-gauge sutureless transconjunctival sclerotomies. Acta Ophthalmol DOI: 10.1111/j.1755-3768.2012. 02441.x.
42.
Keshavamurthy R, Venkatesh P, Garg S: Ultrasound biomicroscopy findings of 25 G transconjunctival sutureless (TSV) and conventional (20 G) pars plana sclerotomy in the same patient. BMC Ophthalmol 2006;6:7.
43.
López-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.
44.
Kwok AK, Tham CC, Loo AV, Fan DS, Lam DS: Ultrasound biomicroscopy of conventional and sutureless pars plana sclerotomies: a comparative and longitudinal study. Am J Ophthalmol 2001;132:172-177.
45.
Acar N, Kapran Z, Unver YB, Altan T, Ozdogan S: Early postoperative hypotony after 25-gauge sutureless vitrectomy with straight incisions. Retina 2008;28:545-552.
46.
Woo SJ, Park KH, Hwang JM, Kim JH, Yu YS, Chung H: Risk factors associated with sclerotomy leakage and postoperative hypotony after 23-gauge transconjunctival sutureless vitrectomy. Retina 2009;29:456-463.
47.
Faia LJ, McCannel CA, Pulido JS, Hatfield RM, Hatfield ME, McNulty VE: Outcomes following 25-gauge vitrectomies. Eye (Lond) 2008;22:1024-1028.
48.
Scott IU, Flynn HW Jr, Dev S, Shaikh S, Mittra RA, Arevalo JF, Kychenthal A, Acar N: Endophthalmitis after 25-gauge and 20-gauge pars plana vitrectomy: incidence and outcomes. Retina 2008;28:138-142.
49.
O'Reilly P, Beatty S: Transconjunctival sutureless vitrectomy: initial experience and surgical tips. Eye (Lond) 2007;21:518-521.
50.
Lommatzsch A, Heimes B, Trieschmann M, Spital G, Pauleikhoff D: Langzeitergebnisse nach Pars-plana-Vitrektomie mit 25-Gauge-Technik. Ophthalmologe 2008;105:445-451.
51.
El-Batarny AM: Transconjunctival sutureless 23-gauge vitrectomy for vitreoretinal diseases: outcome of 30 consecutive cases. Middle East Afr J Ophthalmol 2008;15:99-105.
52.
Romano MR, Das R, Groenwald C, Stappler T, Marticorena J, Valldeperas X, Wong D, Heimann H: Primary 23-gauge sutureless vitrectomy for rhegmatogenous retinal detachment. Indian J Ophthalmol 2012;60:29-33.
53.
Park DH, Shin JP, Kim SY: Comparison of clinical outcomes between 23-gauge and 20-gauge vitrectomy in patients with proliferative diabetic retinopathy. Retina 2010;30:1662-1670.
54.
Parolini B, Prigione G, Romanelli F, Cereda MG, Sartore M, Pertile G: Postoperative complications and intraocular pressure in 943 consecutive cases of 23-gauge transconjunctival pars plana vitrectomy with 1-year follow-up. Retina 2010;30:107-111.
55.
de Preobrajensky N, Mrejen S, Adam R, Ayello-Scheer S, Gendron G, Rodallec T, Sahel JA, Barale PO: Vitrectomie transconjonctivale 23-gauge: étude rétrospective de 164 cas consécutifs. J Fr Ophtalmol 2010;33:99-104.
56.
Schweitzer C, Delyfer MN, Colin J, Korobelnik JF: 23-gauge transconjunctival sutureless pars plana vitrectomy: results of a prospective study. Eye (Lond) 2009;23:2206-2214.
57.
Ibarra MS, Hermel M, Prenner JL, Hassan TS: Longer-term outcomes of transconjunctival sutureless 25-gauge vitrectomy. Am J Ophthalmol 2005;139:831-836.
58.
Chang CJ, Chang YH, Chiang SY, Lin LT: Comparison of clear corneal phacoemulsification combined with 25-gauge transconjunctival sutureless vitrectomy and standard 20-gauge vitrectomy for patients with cataract and vitreoretinal diseases. J Cataract Refract Surg 2005;31:1198-1207.
59.
Oshima Y, Wakabayashi T, Sato T, Ohji M, Tano Y: A 27-gauge instrument system for transconjunctival sutureless microincision vitrectomy surgery. Ophthalmology 2010;117:93-102.
60.
Patelli F, Radice P, Zumbo G, Frisone G, Fasolino G: 25-gauge macular surgery: results and complications. Retina 2007;27:750-754.
61.
Scott IU, Flynn HW Jr, Acar N, Dev S, Shaikh S, Mittra RA, Arevalo JF, Kychenthal A, Kunselman A: Incidence of endophthalmitis after 20-gauge vs 23-gauge vs 25-gauge pars plana vitrectomy. Graefes Arch Clin Exp Ophthalmol 2011;249:377-380.
62.
Shimada H, Nakashizuka H, Hattori T, Mori R, Mizutani Y, Yuzawa M: Incidence of endophthalmitis after 20- and 25-gauge vitrectomy causes and prevention. Ophthalmology 2008;115:2215-2220.
63.
Cohen SM, Flynn HW Jr, Murray TG, Smiddy WE: Endophthalmitis after pars plana vitrectomy. The Postvitrectomy Endophthalmitis Study Group. Ophthalmology 1995;102:705-712.
64.
Kunimoto DY, Kaiser RS, Wills Eye Retina Service: Incidence of endophthalmitis after 20- and 25-gauge vitrectomy. Ophthalmology 2007;114:2133-2137.
65.
Chen JK, Khurana RN, Nguyen QD, Do DV: The incidence of endophthalmitis following transconjunctival sutureless 25- vs 20-gauge vitrectomy. Eye (Lond) 2009;23:780-784.
66.
Rizzo S, Belting C, Cresti F, Genovesi-Ebert F: Sutureless 25-gauge vitrectomy for idiopathic macular hole repair. Graefes Arch Clin Exp Ophthalmol 2007;245:1437-1440.
67.
Guyomarch J, Delyfer MN, Korobelnik JF: Vitrectomie transconjonctivale 25 gauge: à propos de 110 yeux opérés. J Fr Ophtalmol 2008;31:473-480.
68.
Kim MJ, Park KH, Hwang JM, Yu HG, Yu YS, Chung H: The safety and efficacy of transconjunctival sutureless 23-gauge vitrectomy. Korean J Ophthalmol 2007;21:201-207.
69.
Lakhanpal RR, Humayun MS, de Juan E Jr, Lim JI, Chong LP, Chang TS, Javaheri M, Fujii GY, Barnes AC, Alexandrou TJ: Outcomes of 140 consecutive cases of 25-gauge transconjunctival surgery for posterior segment disease. Ophthalmology 2005;112:817-824.
70.
Lewis H: Sutureless microincision vitrectomy surgery: unclear benefit, uncertain safety. Am J Ophthalmol 2007;144:613-615.
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