Learning curve of sutureless transconjunctival 20-gauge vitrectomy
Clinical Ophthalmology
Learning curve of sutureless transconjunctival 20-gauge vitrectomy
0 Department of Ophthalmology, Faculty of Medicine, Christian University of indonesia , Jakarta
1 Cikini eye institute, Cikini CCi Hospital , Jakarta
2 Department of Ophthalmology, Padjadjaran University , Jawa Barat
3 Cicendo eye Hospital , Bandung, indonesia
4 Department of Ophthalmology, G Gennimatas General Hospital, University of athens
5 athens retina institute , athens , Greece
6 Gilbert Ws simanjuntak
7 eustratios V Gotzaridis
3 2 0 2 - n u J - 4 0 n o / m o c . s s e r p e v o dead roF arief s Kartasasmita 3,4 ilias Georgalas 5 Background: To report the learning curve of transition from 20-gauge (20 G) conventional vitrectomy to a 20 G sutureless vitrectomy technique. Materials and methods: This is a retrospective descriptive case study of 32 eyes from 32 consecutive patients who underwent sutureless 20 G pars plana vitrectomy. A 20 G microvitreoretinal blade was introduced, beveled transconjunctivally, slowly, parallel with the limbus, creating a conjunctivoscleral tunnel incision. Study participants were divided into three groups, and surgical time, induced astigmatism, and complications were compared. Results: Of 32 consecutive patients, there was no significant difference in induced astigmatism or maneuvering between the early learning curve and other groups. The true learning curve was the first three patients. There were three cases where suturing the sclerotomy was necessary: one port in each case, three of 32 cases (9.3%), or three of 96 ports (2.9%). Conclusion: There were no significant difficulties in surgical maneuvers while performing 20 g sutureless vitrectomy.
sutureless; vitrectomy; 20 G; learning curve
-
open access to scientific and medical research
Introduction
Since Machemer et al invented closed intraocular microsurgery in 1971,1 the practice
of pars plana vitrectomy using 20-gauge vitrectomy instruments through the sclera,
following incision of the conjunctiva, has been the standard procedure for decades.
However, there are a number of problems associated with 20 G vitrectomy, such as
iatrogenic retinal breaks, particularly those associated with sclerotomies, and the extra
time required to create and suture the sclerotomies. Therefore, sutureless
transconjunctival vitrectomy (TCV) was developed aimed at several advantages, such as less time
required to create the sclerotomies, less postoperative inflammation, less operative
corneal change, and faster recovery.2–4
Fujii et al introduced 25 G TCV, which allowed smaller sclerotomies that were
thought to reduce surgically induced trauma.5,6 Eckardt then developed 23 G TCV to
combine the minimally invasive TCV with the benefits of sturdier, larger instruments
for more complex maneuvers.7 Moreover, the recently developed 27 G TCV by Oshima
et al8 promised more safety from wound leakage and endophthalmitis. Despite the
advantages, these small-gauge instruments may also have some disadvantages, such
as the increased flexibility of the smaller instruments, breakage of fragile instruments,
small vitrector port size, and an initial learning curve in wound construction. These
inventions also involve higher cost in purchasing new equipment for performing
23 G, 25 G, and 27 G vitrectomy, since these procedures require additional specially
designed intraocular instruments other than the ones required for conventional 20 G
vitrectomy.
A 20 G transconjunctival technique using standard
instrumentation without wound sutures has recently been
introduced, with promising results.9,10 This technique has the
advantages of a small-port TCV system without the
necessity of new instrumentation other than the 20 G standard.
This technique also has other 20 G advantages, including
efficient surgery time and instrument rigidity. However,
using sutureless 20 G system requires a learning curve,
since this technique has a different approach compared
with ordinary 23 G or 25 G systems that are commercially
available.
In this study, we report our experience of the use of
20 G TCV in order to assess the efficiency and reliability
of this surgical technique, including the transition from the
conventional to the sutureless system.
Materials and methods
The study was done at the Department of Ophthalmology,
Christian University of Indonesia/Cikini Church Hospital,
Jakarta, Indonesia. Informed consent was obtained from
the study participants, and conducted following the tenets
of the Declaration of Helsinki. The Christian University
of Indonesia Institutional Review Board granted approval
for this study. This was a descriptive study. The inclusion
criteria were patients vitrectomized with a transconjunctival
sutureless 20 G technique. Patients with opened and sutured
conjunctiva (patient with encircling band, etc) were excluded
from the study. Sutureless 20 G TCV was performed in
all patients; intra- and postoperative complications were
documented. The surgical tech (...truncated)