Fatih Horozoglu, MD, Ates Yanyali, MD, Erkan Celik, MD, Ahmet F. Nohutcu, MD, Department of Ophthalmology, Istanbul Haydarpasa Numune Education and Research Hospital, Istanbul, Turkey

Purpose:

To evaluate the effectiveness, feasibility and safety of the transconjunctival sutureless vitrectomy (TSV) system for diabetic vitreous hemorrhage and macular edema.

Methods:

In this retrospective study, we evaluated 33 eyes of 33 patients who underwent pars plana vitrectomy (PPV) with 25 G TSV system. The indications for surgical intervention were diabetic vitreous hemorrhage (21 eyes) and diabetic macular edema (12 eyes).
Internal limiting membrane removal using 25 G intraocular forceps, endolaser photocoagulation and air-fluid exchange were performed when required. Main outcome measures were intraocular pressure, visual acuity, intraoperative and postoperative complications.

Results:

Preoperative visual acuity was between light perception and 3/10; whereas, postoperative visual acuity was between 1/10 and 8/10. Visual acuity improved in all cases and no major intraoperative complications were observed. No difficulties were encountered while passing through the sclerotomies with the instruments, and the required procedures were performed easily. The surgery was completed without conjunctival and scleral suturing in all eyes. Three eyes (9%) had relatively low intraocular pressure (6-9mmHg) on the first postoperative day; but intraocular pressure was normalized within 1 week without affecting the visual outcome. Three eyes (9%) had transient increase of intraocular pressure controlled by topical antiglaucomatous medications. Vitreous hemorrhage recurred in 3 eyes. These eyes underwent vitreous washout using 25 G TSV system, and vitreous hemorrhage did not recur.

Conclusion:

The TSV system was observed to be feasible, effective and safe in diabetic vitreous hemorrhage and macular edema. This minimally invasive and completely sutureless (transconjunctival) technique appears to decrease the convalescence period, operating time and postoperative inflammatory response, and improve patient comfort.

Take-home message:

The TSV system is a feasible, effective and safe method in diabetic vitreous hemorrhage and macular edema.