Article
Three-dimensional self-sealing “screwcut”-incision – a novel approach to sutureless transconjunctival vitrectomy
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Authors
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Lars-Olof Hattenbach
- Hospital of the City of Ludwigshafen, Eye Clinic
| Published: | September 21, 2010 |
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Outline
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Purpose: Flattened sclerotomies are an essential step in ensuring postoperative wound stability in transconjunctival sutureless vitrectomy. However, in complex cases, conventional angled incisions often leak at the end of the procedure. In the present study, we evaluated the outcome of 23-gauge sutureless vitrectomy in various vitreoretinal disorders using a novel self-sealing incision technique.
Methods: Retrospective, noncomparative interventional case series. Thirty eyes of 30 patients underwent complete vitrectomy with shaving of the vitreous base, laser application and peeling of surface membranes using a 23-gauge one-step microcannula array with sharp solid trocar blades and a novel curved and twisted (“screw”-like) self-sealing incision technique. All operations were performed bimanually with 25-gauge chandelier illumination. Indications included epiretinal membrane (n=17), macular hole (n=5), and proliferative diabetic retinopathy (n=3). Primary outcome measures included occurrence of an intra- or postoperative complication such as retinal tears, retinal detachment, vitreous hemorrhage, postoperative hypotony (≤5 mmHg), conversion to 20-gauge vitrectomy or need for scleral sutures.
Results: The 23-gauge incisions were self-sealing in all eyes. In one patient with severe peripheral retinal degeneration and tractional tears requiring silicone oil tamponade, all pars plana incisions were sutured prophylactically. However, of 30 patients, 8 (26.6%) required suturing of the 25-gauge straight two-step chandelier incision. There was no postoperative hypotony, choroidal effusion or vitreous hemorrhage and no postoperative endophthalmitis was observed.
Conclusions: This new approach to 23-gauge sutureless surgery combining a sharp trocar blade and a curved and twisted incision (“screwcut”) provides excellent wound closure and potentially minimizes the risk of wound leak. The finding that straight 25-gauge incisions frequently necessitated suturing underscores the role of careful wound construction in cases that require a very complete vitrectomy.
