Transconjunctival sutureless vitrectomy: initial experience and surgical tips

Abstract

We report the operative details and surgical outcomes of 39 consecutive transconjunctival sutureless vitrectomies using the TSV 25™ system. We retrospectively reviewed the medical records of 35 patients (39 eyes) who underwent surgery using TSV 25™ at the Department of Ophthalmology, Waterford Regional Hospital between March 2003 and February 2005. Preoperative, intraoperative and postoperative details were recorded and analysed. We also performed a systematic review of our surgical technique. Mean (±SD; range) duration of surgery was 32.85 (17.54; 5–85) min. Methods of anaesthesia included retrobulbar anaesthesia (31; 79.5%) and general anaesthesia (8; 20.5%). The mean (±SD; range) length of stay was 1.53 (1.25; 0–4) days. Mean (±SD; range) visual acuities (logMAR) were −1.335 (1.15; 0.0 to −3.0) and −0.803 (1.03; 0.1 to −3.0) preoperatively and postoperatively, respectively. The mean (±SD) intraocular pressures were 14.69 (4.64) mmHg and 11.56 (9.03) mmHg preoperatively and at the first dressing, respectively. Intraoperative complications included blockage of the TSV™ cutter tip during attempted clearance of organized intragel haemorrhage, thus requiring conversion to conventional trans pars plana vitrectomy (1; 2.6%). No other intraoperative complication arose. Complications in the postoperative period included: reactivation of dormant chorioretinal toxoplasmosis (1; 2.6%); postoperative posterior segment haemorrhage (3; 7.7%); hyphaema (1; 2.6%); transient postoperative hypotony (10; 25.6%). With appropriate case selection, and with appreciation of this technique's limitations, transconjunctival sutureless vitrectomy is a safe procedure.