Yusuf Akar, K. Cemil Apaydin, Mustafa Unal, Erkan Coban, Koray Demir, Koray Ahat, Meryem Guler, Pinar Tavas (Antalya, Turkey)

Advantages:

23 Gauge transconjunctival sutureless vitrectomy appears to be a feasible option in treating vitreoretinal complications in diabetic patients, with the potential benefit of reducing postoperative ocular irritation.

Methods:

Seventy four eyes of 76 consecutive patients with diabetes mellitus who underwent 23 Gauge TSV for the treatment of diabetic macular edema, vitreous hemorrhage or traction retinal detachment and 67 control patients with diabetes mellitus who had underwent conventional 20 Gauge PPV were studied. Postoperative pain was evaluated.

Effectiveness / Safety:

The mean duration of surgery in the 23 Gauge TSV group was not statistically significantly different than that in the 20 Gauge PPV group. The mean visual acuity at both 1 week and 1 month after surgery was statistically significantly better in the 23 Gauge TSV group than in the 20 Gauge PPV group. Complications in the 23 Gauge TSV group were similar to those in the 20 Gauge PPV group. Postoperative pain was significantly less in 23 TSV group than in 20 Gauge TSV group (p=0.05).  The 23 Gauge systems for pars plana vitrectomy offer significantly higher patient comfort during the early postoperative period.

Take home message:

Sutureless posterior segment surgery has the advantages of minimal surgical trauma, faster wound healing, and reduced postoperative astigmatism and the decreased convalescence period. However, longer operation duration and limited peripheral vitreous dissection are disadvantages with smaller gauge systems.