Sutureless vitrectomy found reliable for vitreous loss management

Self-sealing sutureless pars plana vitrectomy is a “safe and reliable” method for managing prolapsed vitreous during cataract surgery, according to a recent publication. The modified vitrectomy procedure offers good visual results, the authors said.

Vinay A. Shah, MD, and Kakarla V. Chalam, MD, PhD, described their experience with the sutureless 25-gauge pars plana vitrectomy technique in 29 eyes with vitreous loss during phacoemulsification.

In their technique, an anterior chamber maintainer is inserted through one limbal paracentesis and an iris spatula through another to clear the corneal wound of vitreous. A self-sealing 25-gauge incision in the pars plana is used to insert the vitreous cutter to perform partial core vitrectomy.

The eyes were analyzed for age, sex, race, posterior segment pathology, systemic illness, laterality of the eye, type of anesthesia used during surgery, IOL placement, visual acuity and postoperative complications. Patients were followed for at least 3 months. The self-sealing technique was not used on eyes with visually significant posterior segment pathology, in monocular patients or in eyes in which there was posterior dislocation of nuclear fragments during the cataract surgery.

Of the 29 eyes, all but one (96.5%) had a best corrected visual acuity of 20/40 or better 3 months postoperatively with the technique. Twenty-one eyes (72.4%) achieved a BCVA of 20/20 at 3 months postop. The researchers said the result compare favorably to other reports of visual results after cataract surgery.

Larger, multicenter studies are needed to confirm the improved safety of the 25-gauge procedure, the study authors noted.

“The higher cost of the 25-gauge vitrectomy unit and instrumentation may be balanced by the avoidance of possible complications that, although rare, can have severe consequences,” the authors said.

The study is published in the July issue of American Journal of Ophthalmology.