Abstract

SA.19.03

Innovations in sutureless minimal invasive vitrectomy

Wiechens B.
Department of Ophthalmology, Klinikum Region Hannover Nordstadt

Objective: Over the past three decades pars plana vitrectomy (PPV) has developed to a standard procedure with good results in formerly untreatable vitreoretinal disorders. By means of a special sclerotomy technique and fibrin-assisted wound closure a sutureless 20 gauge PPV can be performed without limitations in the spectrum of surgical indications. With further evolution of manufaction procedures vitrectomy instruments can be produced that make transconjunctival surgery possible. These trocar-assisted technique markedly reduce the surgical trauma. Systems with a diameter of 25- and 23-gauge are currently available.
Methods: In this lecture own experiences with all 3 techniques in over 600 cases and results of studies in the literature will be presented. Advantages and disadvantages of 25- and 23-gauge PPV will be discussed compared to classical 20-gauge technique.
Conclusions: 25-gauge vitrectomy is favorable in vitreoretinal surgery with minor pathology (e.g. macular pucker). Major drawback is the limited lumen and stiffness of instruments. Sutureless 20-gauge PPV can be applied without limitations. Larger surgical trauma to the conjunctiva with postoperative irritation can be overcome by fibrin-assisted wound closure. 23-gauge PPV has the potential to combine the advantages of a trocar assisted PPV and sutureless 20-gauge PPV.

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