What are the Pros and Cons of 23-g Sutureless vs. 20-g Vitrectomy?

July 24, 2009

A recent study compared 23-gauge sutureless vitrectomy against the traditional 20-gauge system. The main difference between the two systems is the method employed to create the sclerotomies.  The surgery was performed by the same surgeon and the indications for surgery were similar.

The sutureless system involves transconjunctival and transcleral perforation using a cannula system. The cannulas are simply removed at the end of suturing. Suture closure of the sclerotomies and conjunctive is usually not necessary. 23 gauge sclerotomies are self-sealing.

The traditional 20 gauge system involves incising the conjunctiva to gain access to the sclera. Cautery to the sclera and conjunctiva is commonly used to limit bleeding. The sclerotomy is created via a stab incision. Closure of the sclera and conjunctiva requires sutures.

This prospective study compared intra- and post-operative complications between the two systems. Results included a similar rate of intra-operative iatrogenic retinal tears and a faster surgical time for the 23 gauge sutureless vitrectomy.

Post-operative results included; faster tissue healing, less inflammation, less patient discomfort and a decreased incidence of raised IOP.

What does this mean? This a prospective study indicates that the 23-gauge system is just as safe as the traditional 20 gauge system.  It has the advantages of increased operating time.  For the patient, fewer trips to the office due to decreased inflammation, faster healing and little discomfort.  One of those win-win scenarios!

Randall V. Wong, M.D.
Retina Specialist




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