Transconjunctival 20-gauge vitrectomy
Eduardo Büchele Rodrigues (Florianopolis)
Recent transconjunctival sutureless vitrectomy (TSV) systems have been used effectively for
treatment of several diseases including epiretinal membranes, macular holes, sheathotomy
and neurotomy for retinal vein occlusions, treatment of retinopathy of prematurity, and removal
of vitreous hemorrhage or retained lens material. These TSV approaches include decreased
sclerotomy sizes with 23- or 25-gauge incisions. However, these smaller sclerotomy entries are
associated with limited flow rates because of small lumen, and wound leaks due to sutureless
closure. Herein we describe the technique and initial clinical experience with a new transconjunctival
20-gauge vitrectomy surgery.
The 20-gauge transconjunctival vitrectomy consists in a simple technique of four easy steps.
Initially the conjunctiva should be cautherized intensely for preparing the bed for non-bleeding
transconjunctival sclerotomy. The second step involves sclerotomy and placement of the fluid
infusion. Then, vitrectomy may be performed for any type of short duration vitreoretinal surgery. The final step includes one
full-thickness suture through the conjunctiva and sclera. A total of 14 eyes were operated with this technique. The indications
included: five patients (35%) had non-diabetic vitreous hemorrhage, 1 (7%) macular hole, 2 (14%) epiretinal membranes,
three (21%) diabetic vitreous hemorrhage, 1 (7%) had intraocular cystecercosis, and two (14%) central retinal vein
occlusion with neurotomy surgery. The transconjunctival approach was possible with all eyes. No severe complications
including retinal detachment, hypotony, or endophthalmitis, were observed. Minor complications noted were: in three out of
42 sclerotomies (7%) the conjunctiva had to be open for final closure; in two eyes (14%) the infusion extruded intraoperative
but could be quickly repositioned; in 4 (9%) sclerotomies conjunctival hemorrhage was noticed; in one eye (7%) in the
supero-temporal sclerotomy there was massive vitreous incarceration that did not progress into retinal detachment.
In conclusion, we present clinical experience with a transconjunctival 20-gauge vitrectomy system. The transconjunctival
20-gauge vitrectomy is an appropriate method for patients with filtering procedures and patients with ocular surface
disorders. Use of 20-gauge suturing systems eliminates the many wound related problems associated with sutureless
25- and 23-g vitrectomy. The novel transconjunctival 20-gauge vitrectomy surgery provides the best advantages of the three
available systems: 20- 23- and 25-gauge vitrectomy. Little inflammation, decreased operating time, less damage to the
conjunctiva, and fast visual recovery may be achieved with this technique. This technique enables expansion and improvement
of the 20-gauge vitrectomy.